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Sex-Based Intra-individual Variability in Lipoprotein(a) Levels
Session:
Sessão de Comunicações Orais 05 – Para além do LDL: determinantes metabólicos do risco cardiovascular
Speaker:
Carolina Marques Neves
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.1 Risk Factors and Prevention – Epidemiology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Carolina Marques Neves; Marta Catarina Almeida; André Lobo; Eduardo Vilela; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u>Introduction:</u> Cardiovascular diseases (CVD) remain the leading global cause of death, and lipoprotein(a) [Lp(a)] is recognized as an independent risk factor. Although Lp(a) levels are mostly genetically determined and traditionally considered stable, recent studies suggest meaningful intra-individual variability. Sex differences in Lp(a) distribution and prognostic value have also been described.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u>Objectives:</u> The objectives of this study were to assess individual variability in Lp(a) levels by sex and to explore clinical and biochemical predictors of these fluctuations.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u>Methods:</u> A retrospective single-center study included patients who had at least two Lp(a) measurements obtained between January 2022 and April 2025. Demographics, cardiovascular risk factors, history, medication use, and laboratory parameters were collected. Variability between sexes was compared. Chi-square, Mann–Whitney and Kruskal–Wallis tests and logistic regression were used.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u>Results:</u> The study included 221 patients [157 (71%) males]. Lp(a) variation ranged from - 168.30 to 277.10 nmol/L. The distribution of absolute Lp(a) variation is presented in Graph 1. Variation in Lp(a) levels greater than 50 nmol/L or exceeding 25%, defined as relevant, occurred in 121 participants (54.8%), of whom 81 (66.9%) males. Women consistently showed higher baseline Lp(a) (91.95 [155.30] nmol/L <em>versus</em> 40.00 [115.40] nmol/L in the first analysis, p = 0.020; and 91.75 [173.80] nmol/L <em>versus</em> 42.40 [152.50] nmol/L in the second, p = 0.026), and greater absolute fluctuations than men (15.70 [55.35] nmol/L <em>versus</em> 9.50 [33.10] nmol/L, p = 0.049). Independent predictors of variability differed by sex: in men, obesity was associated with variability (OR = 2.818, p = 0.036), while in women, medication changes were the independent determinant (OR = 3.565, p = 0.029). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:NewsGotT"><u>Conclusion:</u> Lp(a) should not be regarded as a fixed, genetically predetermined marker. Instead, it demonstrates clinically relevant intra-individual variability influenced by sex, metabolic status, and therapeutic factors. These findings challenge the adequacy of single lifetime measurements for cardiovascular risk assessment and highlight the need for sex-specific approaches when interpreting Lp(a) levels to improve personalized prevention strategies.</span></span></p>
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