J Clin Lipidol. 2026 Sep 25:S1933-2874(26)00528-3. doi: 10.1016/j.jacl.2026.09.019. Online ahead of print.

ABSTRACT

BACKGROUND: Lipoprotein(a) [Lp(a)] can be reported as mass (mg/dL) or particle concentration (nmol/L). Because Lp(a) acts at the particle level, molar concentration may better reflect biologically relevant exposure.

OBJECTIVE: To compare molar- and mass-based Lp(a) in relation to cardiovascular outcomes, risk classification, LPA genetic variation, and apo(a) isoform phenotype in the Young Finns Study.

METHODS: Molar Lp(a) was measured using a traceable Roche Tina-quant Gen.2 assay and mass using a nontraceable Thermo Fisher assay. Associations with cardiovascular outcomes and aortic valve stenosis were assessed by logistic regression in adults aged ≥40 years (N = 3898). Agreement was assessed using Bland-Altman analysis and guideline-based risk reclassification. Associations with LPA genetic risk score and apo(a) isoform phenotype were assessed using Spearman correlation.

RESULTS: Both metrics showed similar associations across cardiovascular outcomes, with significant associations for coronary artery disease (CAD) and aortic valve stenosis. In fully adjusted CAD models, the odds ratio for the highest vs lowest quintile was 1.55 for molar and 1.67 for mass. Agreement between guideline-based risk categories was 95.6%. Molar assigned 2.9% of individuals to a higher risk category than mass, vs 1.5% in the opposite direction. The molar-to-mass ratio was associated with LPA score and apo(a) isoform size, with greater attenuation after adjustment for molar than mass.

CONCLUSION: Molar and mass showed comparable associations with cardiovascular outcomes. However, molar reporting aligned more closely with the genetic and structural determinants of Lp(a) and more often assigned individuals to higher guideline-based risk categories, supporting continued standardization toward particle-based reporting.

PMID:42881039 | DOI:10.1016/j.jacl.2026.09.019