Testing
One in three stable lipid-clinic patients showed Lp(a) swings over 25%, challenging the once-in-a-lifetime testing dogma (Med Clin (Barc) 2024)
Original title: Temporal variability of Lp(a) in clinically stable patients: Implications for cardiovascular risk assessment
This retrospective study analysed 61 clinically stable lipid-clinic patients who had 171 Lp(a) measurements taken at least four months apart, to test the conventional assumption that Lp(a), being primarily genetically determined, varies minimally over time and needs measuring only once in a lifetime. Thirty-four percent of participants showed a 25% or greater change in Lp(a) from baseline, classified as hypervariable, with men showing slightly greater variability than women. Among hypervariable patients, some moved to a higher Lp(a) risk category and others to a lower one, and menopause was present in all women who showed hypervariable Lp(a). The authors argue these findings challenge reliance on a single lifetime Lp(a) measurement for cardiovascular risk assessment, and suggest repeat testing, particularly for patients near a risk-category threshold, may be clinically valuable.
Original abstract
Objectives: Lipoprotein(a) [Lp(a)] is a significant risk factor for cardiovascular disease, yet it is often overlooked in routine clinical assessments. As a primarily genetically determined risk factor, the traditional recommendation is to assess its level once in a lifetime, as the variability of Lp(a) over time is considered to be minimal. This study aims to evaluate the potential variability of Lp(a) in clinically stable patients and investigate factors contributing to the lack of stable levels.
Methods: A retrospective analysis was conducted on a sample of adult patients attending a lipid clinic. Participants with at least two Lp(a) measurements taken with a minimum interval of four months were included. Lp(a) measurements were performed using the immunoturbidimetric assay. Variability in Lp(a) values was calculated as a percentage change from baseline, with participants exceeding a 25% change classified as having hypervariable Lp(a) levels. Additional clinical and biochemical variables were assessed.
Results: 61 participants with 171 Lp(a) determinations were included. Thirty-four percent exhibited a variability of 25% or higher (hypervariable). Men showed slightly greater variability than women. Changes in Lp(a) categories were observed among hypervariable patients, with some participants experiencing an increase while others showed a decrease. Menopause was present in all the women with hypervariable levels.
Conclusion: Our study suggests reconsidering the reliance on a single Lp(a) measurement for assessing cardiovascular risk. Repeat measurements, particularly in borderline cases, may be beneficial.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.