How the choice of molar cut-offs changes lipoprotein(a) classification: A real-world analysis of 23 654 adults undergoing lipoprotein(a) testing in Poland

Q: What are the key findings of this study?

Applying PCS/PoLA (75/125 nmol/l) versus ESC/EAS (62/105 nmol/l) Lp(a) cut-offs reclassified 4.5% of adults, reducing high-Lp(a) prevalence from 16.2% to 13.6%.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Adults undergoing lipoprotein(a) testing for atherosclerotic cardiovascular disease risk assessment (n=23654). Intervention: PCS/PoLA categorical thresholds (<75, 75 to <125, ≥125 nmol/l) vs. ESC/EAS-based boundaries (<62, 62 to <105, ≥105 nmol/l). Primary outcome: Assignment to the high-Lp(a) concentration category (≥125 vs ≥105 nmol/l) and overall category discordance (4.5%).

Beata Bobrowska; Zbigniew Siudak; Justyna Domienik‐Karłowicz; Wojciech Zasada; Renata Rajtar-Salwa; Anna Rulkiewicz; Tim Stolpe; Julia Zurawska; Artur Dziewierz

doi:10.33963/v.phj.115502

October 29, 2026Kardiologia PolskaOpen Access

How the choice of molar cut-offs changes lipoprotein(a) classification: A real-world analysis of 23 654 adults undergoing lipoprotein(a) testing in Poland

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Key result

PCS/PoLA cut-offs reduce high-Lp(a) prevalence by ~3 percentage points versus ESC/EAS criteria.

n=23,654

Why the study?

Does applying PCS/PoLA molar cut-offs (75/125 nmol/l) compared to ESC/EAS-based boundaries (62/105 nmol/l) change Lp(a) risk category assignment in adults undergoing routine Lp(a) testing in Poland?

Key Points

To quantify category discordance resulting from different guideline-recommended molar cut-offs for lipoprotein(a) in a large real-world testing cohort.
Retrospective analysis of 23 654 adults tested for lipoprotein(a) in nmol/l within a Polish healthcare network between April 14, 2025, and February 19, 2026.
Operationalized 2025 ESC/EAS-based boundaries (<62, 62 to <105, and ≥105 nmol/l) were compared against 2024 PCS/PoLA cut-offs (<75, 75 to <125, and ≥125 nmol/l).
Multivariable logistic regression in 12 301 complete cases evaluated associations with prevalent atherosclerotic cardiovascular disease.
Switching to PCS/PoLA thresholds reassigned 1057 patients (4.5%) to a lower category, with 610 of 3833 patients (15.9%) at ≥105 nmol/l falling below the ≥125 nmol/l high-risk cut-off.
The proportion of patients classified in the highest category dropped from 16.2% at ≥105 nmol/l to 13.6% at ≥125 nmol/l.
Prevalent ASCVD odds were higher for ≥105 vs. <62 nmol/l (adjusted OR, 1.48; 95% CI, 1.19–1.86) and ≥125 vs. <75 nmol/l (adjusted OR, 1.59; 95% CI, 1.26–2.00), with each doubling above 7.0 nmol/l associated with increased odds (OR, 1.13; 95% CI, 1.07–1.21; P <0.001).

Study Design

Type

Cross-Sectional (n=23,654)

Multicenter

Yes

Structured PICO

Does applying PCS/PoLA molar cut-offs (75/125 nmol/l) compared to ESC/EAS-based boundaries (62/105 nmol/l) change Lp(a) risk category assignment in adults undergoing routine Lp(a) testing in Poland?

P

Population

23,654 adults in Poland (median age 36 years, 63.5% female) undergoing routine lipoprotein(a) testing reported in nmol/l within a private healthcare network.

E

Exposure

Application of 2024 Polish Cardiac Society/Polish Lipid Association (PCS/PoLA) categorical Lp(a) molar thresholds (<75, 75 to <125, and ≥125 nmol/l) and fixed mass-to-molar conversion factors (2.0 to 2.5 nmol/l per mg/dl)

C

Comparator

Operationalized 2025 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) focused update molar boundaries (<62, 62 to <105, and ≥105 nmol/l)

O

Outcome

Assignment to a different Lp(a) concentration category (category discordance) under the PCS/PoLA vs. ESC/EAS-based boundariessurrogate

Main Result

Absolute Event Rate: 13.6% vs 16.2%

Using the higher ≥125 nmol/l cut-off instead of ≥105 nmol/l excludes nearly 1 in 6 patients from the high-Lp(a) risk category despite identical measured concentrations, underscoring the need to interpret Lp(a) continuously within overall cardiovascular risk.

Limitations

Setting within a large private healthcare network and selection bias for Lp(a) testing
Relatively young age (median 36 years) and female predominance (63.5%) of the cohort limiting generalizability
Lack of assay-level information and paired measurements in both mass and molar units
Cross-sectional ascertainment of atherosclerotic cardiovascular disease
Use of complete-case analysis for multivariable regression models
Analytical heterogeneity across assays, apo(a) isoform-related bias, and measurement uncertainty near decision boundaries
Relatively young age and female predominance of the cohort limiting generalizability
Cross-sectional ascertainment of prevalent ASCVD
Use of complete-case regression for ASCVD association analyses

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Implication

Lp(a) threshold choice influences prevalence estimates; leaves open outcome-based validation in prospective cohorts.

Abstract

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Cite This Study

Bobrowska et al. (2026) conducted a cross-sectional in Adults undergoing lipoprotein(a) testing for atherosclerotic cardiovascular disease risk assessment (n=23,654). PCS/PoLA categorical thresholds (<75, 75 to <125, ≥125 nmol/l) vs. ESC/EAS-based boundaries (<62, 62 to <105, ≥105 nmol/l) was evaluated on Assignment to the high-Lp(a) concentration category (≥125 vs ≥105 nmol/l) and overall category discordance (4.5%). Applying PCS/PoLA (75/125 nmol/l) versus ESC/EAS (62/105 nmol/l) Lp(a) cut-offs reclassified 4.5% of adults, reducing high-Lp(a) prevalence from 16.2% to 13.6%.

synapsesocial.com/papers/6aee6c1171a7594806220d19 https://doi.org/10.33963/v.phj.115502

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How the choice of molar cut-offs changes lipoprotein(a) classification: A real-world analysis of 23 654 adults undergoing lipoprotein(a) testing in Poland

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

How the choice of molar cut-offs changes lipoprotein(a) classification: A real-world analysis of 23 654 adults undergoing lipoprotein(a) testing in Poland

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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