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Lipoprotein(a) levels

lpa testing levels

Measurement of Lp(a)

Lp(a) expressed in mass units (mg/dl) is indicative of the mass of the entire particle. This includes apo(a), apoB-100, cholesterol, cholesteryl esters, phospholipids and triglycerides. Because of the heterogeneity in apo(a) size and the presence in most individuals of two different, genetically determined apo(a) isoform sizes, standardisation using a single calibrant material is impossible.11

To improve the accuracy of cardiovascular risk assessment a single measurement of serum Lp(a) is sufficient for most patients.

  • Serum Lp(a) concentrations should be measured using a method where the effect of isoform size has been minimised using appropriate antibodies with calibrators certified for traceability of Lp(a) values to the world health organisation / The International Federation of Clinical Chemistry (WHO/IFCC) reference material. 
  • Results are recommended to be expressed in nmol/l of Lp(a) particles. 
  • Conversion of mass units to molar units or vice versa introduces inaccuracy and should be discouraged. 
  • Currently only assays based on Denka reagents with calibrators traceable in nmol/L to WHO/IFCC reference material can be recommended.11

In a national questionnaire-based survey, based on the responses of 53 UK lipid clinics:12

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National effort is required to provide universal access to Lp(a) measurement and to harmonise the clinical application of this data.

How often should you test patients?

Lp(a) levels need only be measured once, unless a secondary cause is suspected, or specific treatment is instituted in order to lower levels.11

See who to test

References:

  1. Reyes-Soffer G, et al. Arterioscler Thromb Vasc Biol. 2022;42(1):e48–e60.
  2. Kronenberg F. Clin Res Cardiol Suppl. 2019;14(Suppl 1):5–12.
  3. Nordestgaard BG. J Am Coll Cardiol. 2017;70(13):1637–1646.
  4. Wilson DP, et al. J Clin Lipidol. 2019;13(3):374–392.
  5. Pearson CG, et al. Can. J. Cardiol. 2021; 37:1129–1150.
  6. Handelsman Y, et al. Endocr Pract. 2020;26(10):1196–1224.
  7. Grundy SM, et al. Circulation. 2019;139(25):e1082–e1143.
  8. Kronenberg F. Atherosclerosis. 2022;349:123–135.
  9. Kamstrup PR. Clin Chem. 2021;67(1):154–166.
  10. Szarek M, et al. Circulation. 2023;10.1161.
  11. Cegla J, et al. Atherosclerosis. 2019. 291:62-70.
  12. Ansari S, et al. J Clin Lipidol. 2024 Feb 15:S1933-2874(24)00023-0.
     

UK | July 2024 | 443357

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