Temporal Trends in Lipoprotein(a) Concentrations: The Atherosclerosis Risk in Communities Study

BACKGROUND: Plasma lipoprotein(a) (Lp[a]) concentrations are primarily determined by genetic factors and are believed to remain stable throughout life. However, data are scarce on longitudinal trends in Lp(a) concentrations over time. Therefore, it is unclear whether measurement of Lp(a) once in a person's life is sufficient for cardiovascular risk assessment in all adults. METHODS AND RESULTS: Lp(a) concentrations, specifically apolipoprotein(a) concentrations, were measured at visits 4 and 5, ≈15 years apart, in 4734 adult participants of the ARIC (Atherosclerosis Risk in Communities) study (mean age at visits 4 and 5, 60.7±5.1 and 75.5±5.2 years, respectively). Participants were categorized by baseline (visit 4) Lp(a) concentrations as normal (<30 mg/dL), borderline‐high (30–49 mg/dL), or high (≥50 mg/dL). We compared adults with Lp(a) change ≥20 mg/dL between visits and those with Lp(a) change <20 mg/dL. Multivariable logistic regression analysis was used to identify covariates associated with change in Lp(a) over time. At visit 5, 58.1% of participants with borderline‐high Lp(a) concentrations of 30 to 49 mg/dL at visit 4 had high Lp(a) concentrations ≥50 mg/dL. Participants with low Lp(a) (<30 mg/dL) or high Lp(a) (≥50 mg/dL) at visit 4 tended to stay in these respective categories. Black race, female sex, diabetes, hypertension, total cholesterol, and albuminuria were associated with significantly greater probability for Lp(a) change ≥20 mg/dL over time. CONCLUSIONS: Our results suggest that adults with borderline‐high Lp(a) concentrations may be considered for repeat monitoring of Lp(a) over time, particularly if they are Black, women, or have diabetes, hypertension, and/or elevated albuminuria.