The Italian Society for the Study of Atherosclerosis publishes a national consensus on lipoprotein(a) testing and management (Nutr Metab Cardiovasc Dis 2023)

Original title: Consensus document on Lipoprotein(a) from the Italian Society for the Study of Atherosclerosis (SISA)

Nutr Metab Cardiovasc Dis · 19 July 2023 · 9

Chiesa G, Zenti MG, Baragetti A, Barbagallo CM, Borghi C, Colivicchi F, Maggioni AP, Noto D, Pirro M, Rivellese AA, Sampietro T, Sbrana F et al.

This consensus document from the Italian Society for the Study of Atherosclerosis (SISA) reviews Lp(a) genetics, epidemiology, measurement, and current and emerging therapeutic approaches, including data specific to the Italian population. Plasma Lp(a) varies up to about 1,000-fold between individuals but is genetically determined and stable within an individual over time. Mendelian randomisation supports a causal role for Lp(a) in atherosclerotic cardiovascular disease and aortic valve stenosis, and observational data show a linear relationship between Lp(a) and cardiovascular risk. SISA strongly recommends measuring Lp(a) at least once in every patient lifetime, particularly those with familial hypercholesterolaemia, as part of initial lipid screening. Currently, only plasma apheresis and, to a lesser extent, PCSK9 inhibitors lower Lp(a), and the consensus recommends intensive management of other risk factors while awaiting selective Lp(a)-lowering drugs.

Original abstract

Aims: In view of the consolidating evidence on the causal role of Lp(a) in cardiovascular disease, the Italian Society for the Study of Atherosclerosis (SISA) has assembled a consensus on Lp(a) genetics and epidemiology, together with recommendations for its measurement and current and emerging therapeutic approaches to reduce its plasma levels. Data on the Italian population are also provided.

Data Synthesis: Lp(a) is constituted by one apo(a) molecule and a lipoprotein closely resembling to a low-density lipoprotein (LDL). Its similarity with an LDL, together with its ability to carry oxidized phospholipids are considered the two main features making Lp(a) harmful for cardiovascular health. Plasma Lp(a) concentrations vary over about 1000 folds in humans and are genetically determined, thus they are quite stable in any individual. Mendelian Randomization studies have suggested a causal role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis and observational studies indicate a linear direct correlation between cardiovascular disease and Lp(a) plasma levels. Lp(a) measurement is strongly recommended once in a patient's lifetime, particularly in FH subjects, but also as part of the initial lipid screening to assess cardiovascular risk. The apo(a) size polymorphism represents a challenge for Lp(a) measurement in plasma, but new strategies are overcoming these difficulties. A reduction of Lp(a) levels can be currently attained only by plasma apheresis and, moderately, with PCSK9 inhibitor treatment.

Conclusions: Awaiting the approval of selective Lp(a)-lowering drugs, an intensive management of the other risk factors for individuals with elevated Lp(a) levels is strongly recommended.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.