Lp(a): When and how to measure it
Jaimini Cegla1, Michael France2, Santica M Marcovina3
1Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Insights
Standardizing lipoprotein(a) measurement is crucial for cardiovascular disease risk assessment. Addressing challenges in measurement accuracy will improve patient care, especially with new therapies emerging.
Area of Science:
- Clinical Chemistry
- Cardiovascular Medicine
- Lipidology
Background:
- Lipoprotein(a) is a recognized risk factor for cardiovascular disease.
- Clinical use is limited by complex measurement challenges.
- Standardization is needed for accurate risk assessment.
Purpose of the Study:
- To highlight the importance of accurate lipoprotein(a) measurement.
- To address challenges in lipoprotein(a) assay standardization.
- To guide clinical laboratories in selecting appropriate assays.
Main Methods:
- Review of current lipoprotein(a) measurement issues.
- Analysis of UK External Quality Assurance (EQA) scheme results.
- Discussion of standardization needs for clinical practice.
Main Results:
- Significant work is required to standardize lipoprotein(a) measurement in the UK.
- Existing methods face challenges with size heterogeneity, calibrators, protocols, traceability, and units.
- International guidelines increasingly recognize lipoprotein(a) as an independent risk factor.
Conclusions:
- Accurate measurement of lipoprotein(a) is essential for cardiovascular disease risk stratification.
- Standardization efforts are critical given new therapeutic options.
- Guidance is needed for clinical laboratories to ensure reliable testing.
Abstract:
Lipoprotein(a) has long been regarded as a risk factor for cardiovascular disease; however, its routine use in clinical practice has been hampered by difficulties inherent in the measurement of this complex lipoprotein. The major challenges relate to its size heterogeneity and related issues including (1) use of appropriate calibrators (2) standardization of calibration protocols (3) traceability and (4) reporting units. In the UK, results from the current EQA schemes for lipoprotein(a) suggest that there is considerable work required to standardize lipoprotein(a) measurement. This is becoming increasingly pertinent with the increasing recognition of lipoprotein(a) as an independent risk factor for cardiovascular disease in international guidelines and the emergence of novel antisense therapies to effectively reduce lipoprotein(a). This article raises awareness of the importance of measurement of lipoprotein(a) for the assessment of cardiovascular disease risk and gives guidance to clinical laboratories regarding choice of appropriate assays.
