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👉Heterogeneity in Lipoprotein(a) Profile Changes Across the Menopausal Transition ☝️New data challenge the concept of Lp(a) as a truly “once-in-a-lifetime” measurement—particularly across menopause. 1️⃣ In 4,562 women from the UK Biobank, overall changes in Lp(a) over ~4 years were modest. 2️⃣ Among women with baseline Lp(a) 75–125 nmol/L, those transitioning through menopause showed a median increase of 34.9 nmol/L—~4× greater than women remaining pre- or postmenopausal. 3️⃣ 56.4% of these women crossed the clinically relevant ≥125 nmol/L threshold after menopause, versus ~29% in the comparison groups. 4️⃣ After adjustment for age and baseline Lp(a), menopausal transition was associated with a 2.27-fold higher risk of crossing that threshold. ☝️Take-home message: Lp(a) is largely genetically determined, but not necessarily biologically static. Repeat measurement after menopause may be particularly relevant when premenopausal Lp(a) is in the intermediate range 🔗🔓 academic.oup.com/eurjpc/adva… @society_eas

👉The “low cholesterol increases mortality” argument just took another hit. ☝️A new Danish population study spanning nearly 30 years found: 📍Median LDL-C fell from 142 to 124 mg/dL 📍Median non-HDL-C fell from 174 to 150 mg/dL 📍The LDL-C level associated with the lowest mortality shifted downward from 155 to 135 mg/dL 📍The non-HDL-C level associated with the lowest mortality shifted downward from 186 to 162 mg/dL 📍At the same time, overall mortality declined 📍Cardiovascular mortality declined substantially 👉Key takeaways 1️⃣ Lower population LDL-C did not lead to higher mortality. 2️⃣ The “optimal” LDL-C observed in epidemiological mortality curves is not a fixed biological constant. 3️⃣ Mortality nadirs move as populations become healthier, cardiovascular prevention improves, and LDL-C levels decline. 4️⃣ The well-known U-shaped association between LDL-C and mortality is likely driven, at least in part, by reverse causation and residual confounding at the low end. 5️⃣ These findings are fully consistent with the extensive genetic, epidemiological, and randomized trial evidence supporting LDL-C lowering for ASCVD prevention. 👉Bottom line 📍The question is not whether lowering LDL-C increases mortality. 📍This study suggests the opposite concern may have been misplaced all along: 📍As population LDL-C levels fell, mortality did not rise—it fell too. 🔓🔗 atherosclerosis-journal.com/… @society_eas @ATHjournal @BNordestgaard