Is a Single Lipoprotein(a) Measurement Once in a Lifetime Sufficient? The Results from the STAR-Lp(a) Study

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.