Introduction. Patients with severe mental illness (SMI) such as major depression, bipolar disorder, or schizophrenia show a significantly reduced life expectancy, which is predominantly attributable to increased cardiovascular morbidity and mortality in this patient population. Traditional risk factors, lifestyle factors, and adverse effects of psychopharmacological medication only partially account for this elevated risk. Lipoprotein(a) (Lp(a)) is a genetically determined and independent causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This thesis investigates whether Lp(a) levels are altered in psychiatric disorders and whether Lp(a) may contribute to the disproportionate cardiovascular burden in psychiatric patients. Methods. A systematic literature search was conducted in the PubMed database, complemented by manual research. The search focused on studies published from database inception to February 2026 that assessed Lp(a) levels in psychiatric patients. The search strategy was based on the PICO framework and combined terms related to lipoprotein(a), psychiatric diagnoses, and psychotropic medications. Studies were included if they involved adult participants (≥ 18 years), an established psychiatric diagnosis according to ICD or DSM criteria, quantitative Lp(a) measurements, and a healthy control group. A total of 189 publications were identified, and 9 studies met the inclusion criteria and were included in this systematic review. Results. The studies observed heterogeneous, yet mainly positive associations between Lp(a) levels and psychiatric disorders. For depressive disorders, four studies reported a significant positive relationship between Lp(a) and depression, while two studies found no statistically significant differences. One additional study identified a bidirectional association between Lp(a) and depressive disorders, and a large biobank analysis suggested a positive association between Lp(a) and depression that is moderated by inflammation (assessed by hs-CRP). For schizophrenia, two clinical studies reported significantly elevated Lp(a) levels in affected individuals. For bipolar disorder, two case-control studies indicated higher Lp(a) concentrations in patients, while one study suggested a causal relationship with lower Lp(a) levels. Concerning pharmacotherapy, only paroxetine significantly lowered Lp(a) levels in depressive patients in one study. Conclusion. Most of the included studies show an association between increased Lp(a) concentrations and mental health disorders. However, given the limited sample sizes of most studies and diverging findings from more recent studies with larger study populations, it can be suggested that Lp(a) may mediate the comorbidity of cardiovascular and psychiatric disorders, but conclusive evidence remains to be established.
The Role of Lipoprotein(a) in Cardiovascular Risk among Patients with Psychiatric Disorders
Siglreitmeier, L. J. (Autor/-in). 2026
Studienabschlussarbeit: Diplomarbeit