Guidelines
Review calls out ethnic and racial disparities in Lp(a) inheritance as an underappreciated piece of the residual-risk puzzle (J Natl Med Assoc 2024)
Original title: Lp(a) and risk of cardiovascular disease - A review of existing evidence and emerging concepts
This review addresses why atherosclerotic cardiovascular disease (ASCVD), still the leading cause of death among US adults, persists in some populations despite adequate LDL cholesterol lowering and traditional risk factor control. It covers elevated Lp(a) as an independent contributor to this residual risk, alongside its proposed mechanisms of action in ASCVD, testing recommendations, and current and emerging Lp(a)-lowering therapies. Distinctively, the review emphasises ethnic and racial disparities in Lp(a) inheritance and levels as an aspect of Lp(a) biology that clinicians need to understand when applying risk assessment and management strategies across diverse patient populations in the United States.
Original abstract
Cardiovascular disease (CVD) remains the leading cause of death among adults in the United States. There has been significant advancement in the diagnosis and treatment of atherosclerotic cardiovascular disease (ASCVD) and its underlying risk factors. In certain populations, there remains a significant residual risk despite adequate lowering of low-density lipoprotein cholesterol (LDL-C) and control of traditional risk factors. This has led to an interest in research to identify additional risk factors that contribute to atherosclerotic cardiovascular disease. Elevated lipoprotein (a) [Lp(a)] has been identified as an independent risk factor contributing to an increased risk for CVD. There are also ethnic and racial disparities in Lp(a) inheritance that need to be understood. This paper reviews the current literature on lipoprotein a, proposed mechanisms of actions for cardiovascular disease, recommendations for testing, and the current and emerging therapies for lowering Lp(a).
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.