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Value of repeated measurements of lipoprotein (a) to assess cardiovascular risk: a retrospective study
Axelle Deconinck1, Sofia Morra1, Nina Glassée2
1Department of Cardiology, Erasme University Hospital, Brussels, Belgium.
Insights
A single blood test for lipoprotein (a) [Lp(a)] is sufficient to accurately assess cardiovascular risk. This study found minimal false positives or negatives, confirming the reliability of one Lp(a) measurement.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Laboratory Diagnostics
Background:
- Elevated plasma lipoprotein (a) [Lp(a)] levels significantly increase cardiovascular risk.
- Current guidelines suggest a single Lp(a) measurement for risk prediction, but its accuracy is debated.
- The potential for false positives and negatives from a single measurement requires investigation.
Purpose of the Study:
- To evaluate the reproducibility and accuracy of lipoprotein (a) [Lp(a)] measurements.
- To determine the number of false positives and negatives associated with a single Lp(a) measurement compared to multiple measurements.
- To assess the sufficiency of a single Lp(a) test for cardiovascular risk stratification.
Main Methods:
- Retrieved Lp(a) measurements from 2004-2021 from a hospital laboratory database, including patients with repeated measurements.
- Compared first and subsequent Lp(a) measurements across two cohorts with different methodologies (n=2049 and n=309).
- Assessed the impact of a third measurement (n=678) and analyzed results using various Lp(a) thresholds (180, 100, 70, 50 mg/dL).
Main Results:
- A low rate of false negatives (0.8%-1%) and false positives (0.6%-0.3%) was observed with two Lp(a) measurements.
- No significant differences were found across various Lp(a) thresholds or with additional measurements beyond the second.
- Lipoprotein (a) [Lp(a)] determination demonstrated high reproducibility.
Conclusions:
- Lipoprotein (a) [Lp(a)] testing is reproducible and reliable.
- A single Lp(a) measurement is sufficient to accurately determine if a patient's level exceeds established cut-off values.
- Current guidelines regarding single Lp(a) measurements for cardiovascular risk assessment are supported by these findings.
Abstract:
Background: High plasma concentrations of lipoprotein (a) [Lp(a)] are associated with an increased cardiovascular risk. Current guidelines recommend measurement of only a single Lp(a) in an individual's lifetime under specific circumstances to improve cardiovascular risk prediction. Accordingly, the question raised is the number of false positives and negatives missed through only a single measurement.Methods: All Lp(a) measurements between 2004 and March 2021 were retrieved from the laboratory database of the Erasme hospital. Only patients with repeated measurement were included. The first and subsequent Lp(a) measurement were compared. Two different cohorts were studied as a result of a change in Lp(a) determination methodology (n = 2049 and n = 309, respectively). The effects of a third Lp(a) measurement were assessed through binary analyses (n = 678). The 180 mg/dl (430 nmol/L) threshold recommended in the ESC guidelines was assessed first. Analysis was repeated for 100, 70 and 50 mg/dl thresholds of raised Lp(a) levels.Results: A low rate of false negatives (0.8%-1%) and false positives (0.6-0.3%) were revealed with two Lp(a) measurements. There was no difference in regards to the divergent Lp(a) thresholds nor the measurement of Lp(a) on two or three occasions.Conclusion: The present study showed Lp(a) determination to be reproducible. A single measurement is sufficient to assess if a patient exceeds various cut-off values of elevated Lp(a) levels.
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