Impact of lipoprotein (a) on the quantification of LDL-cholesterol
Background: Accurate LDL-C measurement is essential for cardiovascular risk management. The established methods to determine LDL-C also include Lp(a)-C and potentially distort the actual LDL-C value. The need for Lp(a)-adjusted LDL-C remains debated. Our study aimed to evaluate the impact of Lp(a) o...
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| Main Authors: | , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2026
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| In: |
Clinical laboratory
Year: 2026, Volume: 72, Issue: 5, Pages: 1001-1012 |
| DOI: | 10.7754/Clin.Lab.2025.250664 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.7754/Clin.Lab.2025.250664 Verlag, lizenzpflichtig, Volltext: http://www.clin-lab-publications.com/article/5388 
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| Author Notes: | S. Drobnik, A. Koloi, H. Scharnagl, T. Hollstein, U. Kassner, A. Dressel, W. Drobnik, M. Nauck, W. März |
| Summary: | Background: Accurate LDL-C measurement is essential for cardiovascular risk management. The established methods to determine LDL-C also include Lp(a)-C and potentially distort the actual LDL-C value. The need for Lp(a)-adjusted LDL-C remains debated. Our study aimed to evaluate the impact of Lp(a) on the determination of LDL-C. Methods: We included 3,923 datasets from two cohorts. LDL-C was determined by beta-quantification (LDL-CUC), the reference method recommended by the Lipid Research Clinics, and according to Friedewald (LDL-CFW), Martin/Hopkins (LDL-CMH), and Sampson (LDL-CSN). Correction of LDL-C was performed as follows: corrected LDL-C* = crude LDL-C - (Lp(a) x 0.23 + 1.00). Passing-Bablok regression and Spearman correlation were used for intermethod comparisons. Results: Above 10 mg/dL Lp(a) had a significant effect on LDL-CUC. The effect increased with increasing concentrations of Lp(a) levels and, in relative terms, was most pronounced at lower LDL-C values. For Lp(a) > 58 mg/dL, the actual LDL-CUC was overestimated by ≥ 10%, which was considered clinically relevant. Similar overestimations were observed with the Friedewald, Martin/Hopkins, and Sampson formulas, with Friedewald showing the smallest deviation from LDL-C regardless of Lp(a)-correction. Artificial intelligence models showed that it was not possible to raise the suspicion of elevated Lp(a) from the conventional lipid profile. Conclusions: The influence of Lp(a) on the determination of LDL-C may lead to clinically significant overestimations of the actual LDL-C. Therefore, we recommend using Lp(a)-corrected LDL-C when 1) the Lp(a) concentration is high, 2) the LDL-C concentration is low, and 3) the LDL-C-lowering treatment is less effective than expected. |
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| Item Description: | Gesehen am 18.06.2026 |
| Physical Description: | Online Resource |
| DOI: | 10.7754/Clin.Lab.2025.250664 |