Testing
STAR-Lp(a) study finds meaningful Lp(a) drift within 1-3 years in 1,263 patients, challenging the once-in-a-lifetime testing recommendation (Med Sci (Basel) 2025)
Original title: Is a Single Lipoprotein(a) Measurement Once in a Lifetime Sufficient? The Results from the STAR-Lp(a) Study
This study tested whether the guideline assumption that a single lifetime Lp(a) measurement suffices actually holds, by re-measuring Lp(a) in 1,263 patients (68.7% women, median age 69.0 [59.0-75.0] years) after an interval of one to three years. Median Lp(a) was 9.0 ± 19.0 mg/dL at first measurement and 8.8 ± 19.1 mg/dL at the second (P < 0.001); among patients whose level rose (n = 692), the mean increase was 4.1 ± 6.9 mg/dL, and among those whose level fell (n = 483), the mean decrease was 5.6 ± 11.4 mg/dL. Overall, 64.7% of patients changed by 10% or more, 44.3% by 20% or more, 28.2% by 30% or more, and 14.0% by 50% or more, with no significant differences by sex, age, or comorbidities. The authors argue this midterm variability undermines the current one-time-measurement recommendation and warrants its revision.
Original 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. The aim of the study was to assess the midterm variability in Lp(a) levels and its determinants. Methods: The analysis included 1263 patients (68.7% women, median age 69.0 [59.0-75.0] 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. Results: The median Lp(a) level in the first measurement was 9.0 ± 19.0 mg/dl, compared to 8.8 ± 19.1 mg/dL in the second measurement (p < 0.001). The mean increase in Lp(a) level (N = 692) was 4.1 ± 6.9 mg/dL, while the mean decrease (N = 483) was 5.6 ± 11.4 mg/dL. A total of 64.7% of patients exhibited a change in Lp(a) level ≥ 10%, 44.3% ≥ 20%; 28.2% ≥ 30% and 14.0% ≥ 50% of the baseline values. We found no significant differences in the Lp(a) level change related to sex, age, or comorbidities. 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.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.