Lipoprotein(a) in COVID-19: Genetics and inflammation collide

To summarize the currently available evidence on the possible contribution of Lp(a) to the pathogenesis of COVID-19, we carried out an electronic search in PubMed and Scopus to identify all clinical studies where Lp(a) concentration was measured in patients with SARS-CoV-2 infection and compared with healthy controls or correlated with the risk of developing COVID-19 related complications. Although the limited evidence available so far on the potential impact of Lp(a) on the pathogenesis of COVID-19 does not allow to draw definitive conclusions, some important considerations can be drawn. First, Lp(a) is an acute phase reactant, and its concentration can be consistently boosted during sustained inflammatory states, like that characterizing severe forms of COVID-19 and other acute conditions. Then, in all three studies that we could identified based on our digital search, Lp(a) values both at baseline (e.g., presumably genetically determined) or during illness progression (i.e., boosted by COVID-19 related inflammation) were found to have an impact on clinical outcome of SARS-CoV-2 infection. In conclusion, the evidence emerged from our analysis would lead us to conclude that both baseline and serial Lp(a) assessment shall be part of a routine panel of laboratory tests for COVID-19 monitoring, along with other useful parameters.