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About 20% of people have elevated Lp(a), yet guidelines diverge sharply on how to manage it, and youth recommendations barely exist, a review (Curr Opin Endocrinol Diabetes Obes 2021)
Original title: Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a)
This review by Wilson, Koschinsky and Moriarty compares recent recommendations for managing adults and youth with elevated Lp(a), present in approximately 20% of the general population and a well-established causal, independent risk factor for cardiovascular disease, including myocardial infarction, stroke and aortic valve stenosis. Several guidelines and position statements now exist for identifying, treating and following up adults with elevated Lp(a), but recommendations for youth remain limited despite growing interest in early screening and health behaviour strategies. The authors note emerging data from the coronavirus pandemic suggesting adults with elevated Lp(a) may face particularly high cardiovascular complication risk, and that while Lp(a)-specific lowering therapies remain in development, statins, despite not lowering Lp(a) itself, still improve outcomes in primary and secondary prevention. The authors call for more harmonised, comprehensive Lp(a) guidelines covering both adults and youth.
Original abstract
Purpose Of Review: Summarize recent recommendations on clinical management of adults and youth with elevated lipoprotein(a) [Lp(a)] who are at-risk of or affected by cardiovascular disease (CVD).
Recent Findings: There is ample evidence to support elevated Lp(a) levels, present in approximately 20% of the general population, as a causal, independent risk factor for CVD and its role as a significant risk enhancer. Several guidelines and position statements have been published to assist in the identification, treatment and follow-up of adults with elevated levels of Lp(a). There is growing interest in Lp(a) screening and strategies to improve health behaviors starting in youth, although published recommendations for this population are limited. In addition to the well established increased risk of myocardial infarction, stroke and valvular aortic stenosis, data from the coronavirus pandemic suggest adults with elevated Lp(a) may have a particularly high-risk of cardiovascular complications. Lp(a)-specific-lowering therapies are currently in development. Despite their inability to lower Lp(a), use of statins have been shown to improve outcomes in primary and secondary prevention.
Summary: Considerable differences exist amongst published guidelines for adults on the use of Lp(a) in clinical practice, and recommendations for youth are limited. With increasing knowledge of Lp(a)'s role in CVD, including recent observations of COVID-19-related risk of cardiovascular complications, more harmonized and comprehensive guidelines for Lp(a) in clinical practice are required. This will facilitate clinical decision-making and help define best practices for identification and management of elevated Lp(a) in adults and youth.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.