Lipoprotein(a) and clinical characteristics of Polish patients hospitalized in a tertiary referral hospital — an observational, cross-sectional study

To the Editor,

The assessment of lipoprotein(a) [Lp(a)] as an integral element of cardiovascular risk evaluation is gaining increasing importance, particularly in light of the forthcoming therapeutic options specifically targeting this lipoprotein. Therefore, we would like to congratulate the authors for drawing attention to this clinically relevant topic in their recent article [1]. As our research group is also actively involved in studies focusing on Lp(a) [2–5], we follow with interest publications addressing this issue.

When conducting epidemiological research, it is crucial to interpret results in the context of study limitations. In our opinion, the most important limitation of the study by Saniewski et al. [1] lies in the relatively small sample size, which raises concerns regarding the robustness of the conclusions. The compared groups differed substantially in several demographic characteristics, and the lack of statistical significance in these comparisons likely reflects insufficient statistical power rather than true similarity. We believe that further continuation of this project, with a larger sample size, will help address this limitation and allow the use of propensity score matching, thereby increasing the reliability of future results.

In this context, we were also intrigued by the lipid profile data, which appear somewhat inconsistent and therefore merit clarification by the authors. Specifically, in the group with elevated Lp(a), mean low density lipoprotein (LDL) cholesterol was slightly higher, whereas the mean non-high density lipoprotein (HDL) cholesterol was paradoxically lower. Since both Lp(a) and LDL-cholesterol contribute to non-HDL-cholesterol, how should this finding be interpreted? Could it have implications for the overall conclusions of the study? We believe that this interesting observation deserves further discussion and potentially more detailed analysis in future work.