Abstract Background Guidelines suggest that a single lifetime measurement of lipoproteina (a) Lp(a) is sufficient for most patients as its levels are largely genetically determined and do not significantly change over time. Purpose The aim of the study was to assess the midterm variability in Lp(a) levels and its determinants. Methods The analysis included 1,263 patients (80.3% in primary prevention; 68.7% women, the average age was 66.7±12.3 years) who underwent two measurements of Lp(a) levels at an interval of at least one year and up to a maximum of three years. Statistical analysis was performed using the STATISTICA 13.1 software. Results The median Lp(a) level in the first measurement was 22.5 ± 47.5 nmol/l (9.0 ± 19.0mg/dl), compared to 22.0 ± 47.7 nmol/L (8.8 ± 19.1 mg/dL) in the second measurement (p0.001). The mean increase in Lp(a) level (N=692) was 10.8 ± 17.3 nmol/L, while the mean decrease (N=483) was 14.0 ± 28.5 nmol/L. A total of 65.5% of patients exhibited a change in Lp(a) level ≥10%, 44.3% ≥20%; 28.2% ≥30% and 14.0% ≥50% of the baseline values. There were no significant differences in the Lp(a) level change related to sex, age, or comorbidities, except for patients after stroke, who were more likely to exhibit a change of ≥10% in Lp(a) levels between the two measurements (74.5% vs. 63.9%, p=0.04). A correlation analysis was conducted to assess changes in Lp(a) levels in relation to variations in biochemical parameters within selected subgroups. The change in Lp(a) correlated positively with the change in low-density lipoprotein (LDL) levels in the youngest (40 years) and oldest (≥65 years) patients (r=0.21; p=0.04 and r=0.25; p=0.01, respectively). A similar correlation regarding to LDL was observed in patients with hypertension (r=0.30; p=0.001), among whom a comparable association was also found for total cholesterol (r=0.29; p=0.002). Conclusions A significant change in Lp(a) levels was observed in the midterm follow-up. These findings potentially have a profound clinical importance. The current expert recommendation to measure Lp(a) at least once in a lifetime appears to be inaccurate and should be revised.
Burzynska et al. (Sat,) studied this question.