Heterogeneity in Lipoprotein(a) Profile Changes Across the Menopausal Transition.

Area of Science:

• Cardiovascular Science
• Endocrinology
• Lipidology

Background:

• Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Menopause is associated with changes in cardiovascular risk factors, including lipids.
• Understanding Lp(a) dynamics during menopause is essential for risk stratification.

Purpose of the Study:

• To examine changes in serum Lp(a) levels across different menopausal statuses.
• To identify women with significant Lp(a) increases during the menopausal transition.
• To inform recommendations for Lp(a) testing and ASCVD risk assessment.

Main Methods:

• Longitudinal analysis of serum Lp(a) levels from the UK Biobank (N=4,562).
• Stratification by menopausal status: transitioned, premenopausal, and postmenopausal.
• Analysis of Lp(a) changes based on baseline levels and menopausal transition.

Main Results:

• Women transitioning through menopause showed a fourfold greater increase in Lp(a) compared to stable pre- or postmenopausal women.
• Over 50% of women with intermediate baseline Lp(a) (75-125 nmol/L) exceeded the ASCVD risk threshold (≥125 nmol/L) after menopause.
• These changes highlight significant Lp(a) reclassification during the menopausal transition.

Conclusions:

• A single premenopausal Lp(a) measurement may underestimate ASCVD risk.
• Repeat Lp(a) testing during menopause is vital for identifying individuals at high risk.
• Menopause represents a critical window for reassessing Lp(a) and ASCVD risk.