RNA therapeutics
A Global Think Tank of major cardiovascular societies reaches unanimous consensus on standardising Lp(a) measurement, but not on universal screening (J Clin Lipidol 2021)
Original title: JCL Roundtable: Global Think Tank on Lipoprotein(a)
This JCL Roundtable reports on a Global Think Tank convened by the European Atherosclerosis Society, American Heart Association, Preventive Cardiovascular Nurses Association, National Lipid Association, and other groups, addressing Lp(a) causal role in atherosclerosis, arterial thrombosis and aortic stenosis. Inherited variation in Lp(a) substantially raises cardiovascular risk in 20% of people worldwide, with risk rising linearly so those with the highest levels face risk comparable to other severe inherited lipoprotein disorders. The Think Tank reached unanimous consensus on standardised laboratory measurement in nanomoles per litre. European and Canadian societies recommend universal once-in-lifetime screening, though US organisations do not. Current therapies achieve only 20-30% Lp(a) lowering and none has yet been proven in an outcomes trial to reduce risk, while new RNA-targeted therapies, including a liver-directed antisense oligonucleotide now in a large outcomes trial, can achieve 80-90% reduction. The Think Tank calls for a unified global effort on education, standardisation and clinical management.
Original abstract
Lipoprotein(a) operates in causal pathways to promote atherosclerosis, arterial thrombosis, and aortic stenosis. It has been associated with rare cases of nonatherosclerotic arterial thrombotic stroke at any age. Inherited variation of lipoprotein(a) levels substantially increases cardiovascular risk in 20% of people worldwide. Recent progress in identifying the risk associated with lipoprotein(a) and in pursuing effective treatment has led to a recent Global Think Tank including representatives from the European Atherosclerosis Society, American Heart Association, Preventive Cardiovascular Nurses Association, National Lipid Association, and other groups. The need for standardized laboratory measurement in nanomoles per liter met with unanimous consensus. Atherosclerotic risk is linearly associated with plasma lipoprotein(a) levels, so that persons with the highest levels may have risk similar to other severe inherited lipoprotein disorders. Universal once-in-lifetime screening has been recommended by European and Canadian cardiovascular societies, but not by U.S. organizations. Current pharmacologic therapies are limited to 20-30% lowering of lipoprotein(a) levels, and no pharmacologic treatment for lowering lipoprotein(a) has yet been proven to reduce risk in a cardiovascular outcomes trial. Treatment for high-risk patients focuses on reducing low density lipoprotein cholesterol and other risk factors. New therapies targeting messenger RNA for apolipoprotein(a) can achieve 80-90% reduction of lipoprotein(a) levels. One such therapy using a liver-directed antisense oligonucleotide is currently being tested in a large cardiovascular outcomes trial. Increased recognition of lipoprotein(a)-associated risk and emergence of potentially effective therapy together lead to a mandate for a unified global effort on education, standardization, and clinical management.
consensusguidelinesRNA therapeutics
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.