Testing
1 in 5 patients show high Lp(a) variability between tests, with the biggest risk-category churn in the 'gray zone,' Korean multicenter study of 5,305 finds (Lipids Health Dis 2025)
Original title: Predictors of lipoprotein(a) variability in clinical practice and their impact on cardiovascular risk
This retrospective multicenter study drew on data from three tertiary university hospitals in Korea, including 5,305 patients with at least two Lp(a) measurements taken 90 or more days apart, to identify predictors of intra-individual Lp(a) variability and its cardiovascular risk implications. Baseline and follow-up Lp(a) were strongly correlated overall (r = 0.89, P < 0.01), but individual variability was substantial, with a median absolute change of 3.9 mg/dL and a median percentage change of 26.3%; about 19.9% of patients showed high variability (absolute change above 10 mg/dL and relative change above 25%). High variability was associated with lower baseline and higher follow-up Lp(a), lower BMI, higher haemoglobin, elevated white blood cell and platelet counts, higher glucose, lower HDL-C, and antihypertensive medication use, and risk reclassification analysis showed marked movement among patients in the intermediate Lp(a) 'gray zone.' The authors argue serial Lp(a) measurement could refine cardiovascular risk stratification, particularly for intermediate-risk patients, informing future guideline integration.
Original abstract
Background: Lipoprotein(a) (Lp[a]) is an established cardiovascular risk marker; however, its intraindividual variability and implications for risk stratification remain poorly understood. This study investigated the clinical and biochemical predictors of high Lp(a) levels and evaluated their potential roles in cardiovascular risk assessment to inform evidence-based public health strategies for cardiovascular disease prevention.
Methods: This retrospective multicenter observational study was conducted using data from three tertiary university hospitals in Korea. Patients with at least two Lp(a) measurements taken ≥ 90 days apart were included (n = 5,305). High Lp(a)-level variability was defined as an absolute change of > 10 mg/dL and a relative change of > 25%. Predictors of high-variability were identified through regression analyses, and risk reclassification across Lp(a) risk categories was performed.
Results: Baseline and follow-up Lp(a) levels were strongly correlated (r = 0.89, P < 0.01); however, substantial individual variability was observed, with a median absolute change of 3.9 mg/dL and a median percentage change of 26.3%. Approximately 19.9% of the patients exhibited high Lp(a) level variability, which was associated with lower baseline Lp(a) levels and higher follow-up Lp(a) levels, lower body mass indices, higher hemoglobin levels, elevated white blood cell and platelet counts, increased serum glucose levels, lower high-density lipoprotein cholesterol levels, and use of antihypertensive medications. Notably, risk reclassification analysis revealed marked variability among patients in the intermediate "gray-zone."
Conclusions: The findings of this study indicate that Lp(a) level variability is associated with adverse cardiovascular risk profiles and dynamic risk reclassification. These results highlight the potential of serial Lp(a) measurements to refine cardiovascular risk stratification, particularly in intermediate-risk patients. Integrating these findings into clinical practice guidelines has the potential to improve cardiovascular risk management at the population level, reduce healthcare disparities, and inform targeted public health interventions aimed at cardiovascular prevention.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.