Gbaa Terry, Bolodeoku John, Morris Katherine, Whitehead Simon
Lipid Clinic, Cardiology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
Biochemistry, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK*Correspondence: Terry Gbaa. Email:
Qatar Med J. 2025 Mar 5;2025(1):16. doi: 10.5339/qmj.2025.16. eCollection 2025.
Cardiovascular disease (CVD) affects 500 million people globally, with mortality over 20 million. In the UK, the financial burden is estimated to be approximately £54 billion. Consequently, Lp(a) has been incorporated as an additional biomarker for cardiovascular risk stratification. It is used as a superior marker over the traditional marker LDL-C.
This was a single-centre retrospective study conducted at Hampshire Hospital NHS Foundation Trust spanning 16 months (September 2022-January 2024). Lp(a) results were retrieved from the laboratory database and assessed for trends. The distribution of Lp(a) results was also compared with the values outlined in the HEART UK consensus statement (2019). Additionally, demographic characteristics such as age, sex, medical history, and lifestyle factors were collected. Personal details, including names, addresses, and phone numbers, were anonymised to ensure confidentiality. A total of 192 patients were included in the study. These patients were referred for a lipid panel by lipid specialists (172), GP surgeries (10), cardiologists (5), unspecified consultants (3) and endocrinologists (2). All patients were over 18 years of age. They were attending the clinic and had been screened for dyslipidaemia and high cardiovascular risk, including conditions such as familial hypercholesterolaemia, renal dysfunction, and those on antilipid therapy.
The demography included 99 (52%) females and 93 (48%) males. The chronological age (mean ± SD) was 61.17 ± 13.18 for females and 53.91 ± 12.84 for males ( < 0.001). Additionally, the Lp(a) values were 126.50 ± 118.92 and 135.33 ± 99.59 ( < 0.01) for females and males, respectively. The analysed samples were categorised as normal ( ≤ 32 nmol/L) and abnormal (>32 nmol/L) concentrations of Lp(a), with normal results observed in 104 patients and abnormal results in 88 patients: Lp(a) ≤ 32 nmol/L (54%) versus >32 nmol/L (46%), < 0.0001. According to the CVD risk groupings established by HEART UK, 54%, 12%, 18%, 15% and 1% of the patients had Lp(a) values of 12.2 ± 7.5, 52.20 ± 16.42, 147.14 ± 36.64, 291.71 ± 62.49, and 471.50 ± 28.99 nmol/L, classified as normal, minor risk, moderate risk, high risk, and very high risk, respectively.
This study provided evidence supporting the inclusion of Lp(a) as an extra component in lipid profile testing. Elevated levels of Lp(a) are associated with an increased risk of CVD, which may be more significant than the risk posed by LDL-C. Incorporating Lp(a) as a routine biomarker in real-world clinical practice would accurately stratify cardiovascular risk, particularly for patients with elevated Lp(a) concentrations, and could potentially be a more significant risk than LDL-C in individuals at high risk for CVD, especially for those ≥ 50 years of age.
心血管疾病（CVD）在全球影响着5亿人，死亡率超过2000万。在英国，经济负担估计约为540亿英镑。因此，脂蛋白（a）[Lp(a)]已被纳入心血管风险分层的额外生物标志物。它被用作优于传统标志物低密度脂蛋白胆固醇（LDL-C）的标志物。
这是一项在汉普郡医院国民保健服务基金会信托基金进行的单中心回顾性研究，为期16个月（2022年9月至2024年1月）。从实验室数据库中检索Lp(a)结果并评估其趋势。还将Lp(a)结果的分布与英国心脏协会共识声明（2019年）中概述的值进行了比较。此外，收集了年龄、性别、病史和生活方式因素等人口统计学特征。包括姓名、地址和电话号码在内的个人详细信息进行了匿名处理以确保保密性。共有192名患者纳入研究。这些患者由脂质专家（172例）、全科医生诊所（10例）、心脏病专家（5例）、未指明的顾问（3例）和内分泌专家（2例）转诊进行血脂检测。所有患者均年满18岁。他们前来就诊，并已接受血脂异常和高心血管风险筛查，包括家族性高胆固醇血症、肾功能不全等疾病以及接受抗血脂治疗的患者。
人口统计学数据包括99名（52%）女性和93名（（48%）男性。女性的实际年龄（平均值±标准差）为61.17±13.18岁，男性为53.91±12.84岁（P<0.001）。此外，女性和男性的Lp(a)值分别为126.50±118.92和135.33±99.59（P<0.01）。分析的样本根据Lp(a)浓度分为正常（≤32 nmol/L）和异常（>32 nmol/L），104例患者结果正常，88例患者结果异常：Lp(a)≤32 nmol/L（54%）与>32 nmol/L（46%），P<0.0001。根据英国心脏协会建立的心血管疾病风险分组，54%、12%、18%、15%和1%的患者Lp(a)值分别为12.2±7.5、52.20±16.42、147.14±36.64、291.71±62.49和471.50±28.99 nmol/L），分别分类为正常、低风险、中度风险、高风险和极高风险。
本研究提供了证据支持将Lp(a)纳入血脂检测的额外项目。Lp(a)水平升高与心血管疾病风险增加相关，这可能比LDL-C带来的风险更显著。在实际临床实践中将Lp(a)作为常规生物标志物将准确地对心血管风险进行分层，特别是对于Lp(a)浓度升高的患者，并且在心血管疾病高风险个体中，尤其是≥50岁的个体中，Lp(a)可能是比LDL-C更显著的风险因素。
