The burden of Lipoprotein(a) [Lp(a)] in Africa: A systematic review

Lipoprotein(a) [Lp(a)] is a low-density lipoprotein-like particle covalently bound to apolipoprotein(a) and encoded by the LPA gene. Elevated plasma levels of Lp(a) are a well-established, independent, and causal risk factor for cardiovascular disease. While the epidemiology of Lp(a) has been extensively mapped in non- African populations, the burden and distribution of Lp(a) in African populations remain under-characterized despite its unique genetic, phenotypic, ethnolinguistic and ancestral diversity. The primary objective was to synthesize existing literature to determine the prevalence and distribution of elevated Lp(a) levels in apparently healthy African individuals residing on the African continent.

This systematic review included observational studies (cross-sectional, cohort, and case-control) involving apparently healthy adults (≥18 years) in Africa. The review systematically searched PubMed/MEDLINE, Embase, Scopus, African Journals Online, and Google Scholar without language or date restrictions to capture the full breadth of historical and contemporary data. Data were extracted using a standardized form capturing study characteristics, population demographics, assay methods and quantitative outcomes. Methodological quality was assessed using the Newcastle-Ottawa Scale.

A total of 17 studies met the inclusion criteria, representing populations from West Africa (Nigeria, Ghana) Central Africa (Cameroon), Southern Africa (South Africa, Zimbabwe), and North Africa (Morocco, Tunisia). Studies in Ghana reported prevalence rates of elevated Lp(a) (>30 mg/dL) between 30-61%. Lp(a) mean levels ranged from 12.7 mg/dL to 54.5 mg/dL depending on the cohort and assay used. Females exhibited higher Lp(a) levels than males across most African cohorts. Clinically, elevated Lp(a) was associated with hypertension, type 2 diabetes mellitus, ischemic stroke, myocardial infarction and anti-retroviral drug use.

Elevated Lp(a) is a common, genetically determined trait in Africa rather than a rare dyslipidemia. Far from being a benign variant, it acts as a significant amplifier of cardiovascular risk, particularly in the presence of rising incident rates of hypertension and diabetes. Addressing this burden requires the adoption of standardized, isoform-independent assays and the development of population-specific risk thresholds to guide targeted preventive cardiovascular care.