Lipoprotein(a) Measurement in Lipoprotein Apheresis: Time to Change?

The question of standardizing the measurement of lipoprotein(a) [Lp(a)] has been discussed for many years, but the unavailability of automated methods insensitive to the structural heterogeneity of Lp(a) and the transition to a new unit of measurement have delayed this process. The aim of this study is to compare, in subjects undergoing regular lipoprotein apheresis (LA) treatment (31 subjects, mean age 62 ± 11 years, female 7/31), Lp(a) measurements performed using routine polyclonal antibodies with a method that recognizes a single copy of apo(a) per molecule. This pilot study for adopting an assay insensitive to apo(a) size polymorphism showed a good match with the traditional method: correlations between pre-LA and post-LA measures show an R² of 0.89 and 0.76, respectively. Despite the interpretative problem caused by adopting different units of measurement, we believe that moving to an assay insensitive to the dimensional variation of apo(a) represents a necessary change to standardize, improve, and extend the accuracy and diagnostic power of Lp(a).