Testing
A repeat Lp(a) test reclassifies over half of patients out of the EAS 'grey zone', in a study of 609 individuals (Eur Heart J Open 2024)
Original title: Intra-individual variability in lipoprotein(a): the value of a repeat measure for reclassifying individuals at intermediate risk
This retrospective cohort study examined intra-individual variability in Lp(a) using paired initial and repeat measurements, taken with the same assay methodology, from 609 individuals in the Nashville Biosciences electronic medical records database. Baseline and follow-up Lp(a) values differed significantly (P < 0.05), with an absolute change of 10 mg/dL or more in 38.1% of individuals (95% CI 34.2-42%) and a relative change over 25% in 40.5% (95% CI 36.6-44.3%). While individuals initially in the European Atherosclerosis Society (EAS) low-risk or high-risk categories rarely changed category, 53% of those initially in the intermediate 'grey-zone' category reclassified to either low-risk (20%) or high-risk (33%) on repeat testing. Black individuals and women showed greater variability than White individuals and men respectively, and larger baseline Lp(a) predicted larger absolute change (r = 0.59, P < 0.01). A repeat Lp(a) measurement, previously assumed clinically unnecessary given Lp(a)'s strong genetic determination, meaningfully refines risk classification specifically for patients in the intermediate zone.
Original abstract
Aims: Lipoprotein(a) [Lp(a)] levels are predominantly genetically determined and repeat measurements are generally considered unlikely to be clinically useful. However, the temporal variation of Lp(a) is not well characterized. Our aim was to determine the intra-individual variability of Lp(a) and whether a repeated measure reclassified Lp(a)-specific cardiovascular risk using the European Atherosclerosis Society (EAS) consensus statement risk categories.
Methods And Results: This retrospective cohort study analysed initial and repeated serum Lp(a) levels measured using the same methodology from 609 individuals in the Nashville Biosciences database, a de-identified electronic medical records database. Baseline and follow-up paired values were significantly different (P < 0.05), with an absolute change of ≥10 mg/dL in 38.1% [95% CI 34.2-42%] and a >25% change in 40.5% [95% CI 36.6-44.3%] of individuals. Although the categories of those whose values were in the EAS low-risk and high-risk categories did not change, 53% of those in the intermediate 'grey-zone' category transitioned to either the low-risk (20%) or high-risk (33%) category. Black individuals exhibited greater variability than White individuals and women exhibited greater variability than men. There was a positive correlation between the baseline Lp(a) levels and the absolute changes in Lp(a), (r = 0.59, P < 0.01).
Conclusion: Temporal-related changes in Lp(a) variability were present in many individuals. A repeat Lp(a) measure may allow more precise Lp(a)-specific cardiovascular risk prediction for individuals whose initial value is in the EAS-defined intermediate 'grey-zone' category. Lp(a) variability should be included in calculating the expected effect sizes in future clinical research studies targeting Lp(a).
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.