title: Prevalence of Elevated Lp(a) Mass Levels and Patient Thresholds in 532 359 Patients in the United States.
abstract: Elevated lipoprotein(a) [Lp(a)] is a causal, independent risk factor for cardiovascular disease and aortic stenosis. We aimed to define the prevalence and patient thresholds of elevated Lp(a) levels in the United States.
  
  
  
  We analyzed Lp(a) levels in 532 359 subjects from 2 data sets: (1) in 531 144 subjects from a referral laboratory and (2) in 915 patients from a tertiary referral center. Lp(a) mass levels were measured by immunoturbidometric assays in both centers and expressed as mg/dL. At the referral laboratory, the median age (interquartile range) of the subjects was 57.0 (46-67) years, and 51.9% were female. Lp(a) levels were skewed rightward as expected. The mean±SD levels were 34.0±40.0 mg/dL, and median (interquartile range) levels were 17 (7-47) mg/dL, with range 0 to 907 mg/dL. Lp(a) levels at 75%, 80%, 90%, 95%, 99%, and 99.9% percentiles were >47, >60, >90, >116, >180, and >245 mg/dL, respectively. At the referral laboratory, Lp(a) levels >30 and >50 mg/dL were present in 35.0% and 24.0% of subjects, respectively, and at the tertiary referral center, 39.5% and 29.2%, respectively. Females had higher mean (SD) (37.0 [42.7] versus 30.7 [36.7]; P<0.0001) and median (interquartile range) (19 [8-53] versus 15 [7-42]; P<0.0001) Lp(a) than males.
  
  
  
  This is the largest database to assess the distribution of Lp(a) and is derived from patients as opposed to general populations. Lp(a) levels >30 and >50 mg/dL were fairly common, particularly in a tertiary care setting. These data may inform consensus documents, guidelines, and therapeutic cutoffs for Lp(a)-mediated cardiovascular risk.
authors.affiliation: From the Salveo Diagnostics, LLC, Richmond, VA (S.V., J.P.M.); and Department of Medicine, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (S.T.).
authors.forename: Steve
authors.initials: S
authors.lastname: Varvel
authors.affiliation: From the Salveo Diagnostics, LLC, Richmond, VA (S.V., J.P.M.); and Department of Medicine, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (S.T.).
authors.forename: Joseph P
authors.initials: JP
authors.lastname: McConnell
authors.affiliation: From the Salveo Diagnostics, LLC, Richmond, VA (S.V., J.P.M.); and Department of Medicine, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, La Jolla (S.T.). stsimikas@ucsd.edu.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsimikas
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D016208:Databases, Factual; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011237:Predictive Value of Tests; D015995:Prevalence; D012016:Reference Values; D012307:Risk Factors; D012737:Sex Factors; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D002097:C-Reactive Protein; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007328:Insulin; D017270:Lipoprotein(a); C517652:hemoglobin A1c protein, human
keywords: aortic stenosis; atherosclerosis; cardiovascular disease; guidelines; lipoprotein(a); population; prevalence