Guidelines
Practical guidance review outlines managing elevated Lp(a) today while four RNA-based agents complete outcome trials (South Med J 2024)
Original title: Elevated Lp(a): Guidance for Identifying and Managing Patients
This clinically oriented review outlines how to identify and manage patients with elevated Lp(a), an independent and causal risk factor for ASCVD and calcific aortic valve stenosis affecting roughly 20% of the general population, the most common genetic dyslipidaemia. Lp(a) is highly genetic and minimally responsive to lifestyle measures, with levels at or above 125 nmol/L associated with increased ASCVD risk, though this threshold is not yet universally accepted. Available PCSK9 inhibitors produce only moderate Lp(a) reductions and none is indicated specifically for elevated Lp(a), but four investigational RNA-based agents now reduce Lp(a) by 70% to 100%, with two currently in adequately powered outcome trials expected to report in two to three years. Until such therapies are approved and proven to improve outcomes, the authors recommend early, intensive management of other ASCVD risk factors as the primary strategy for patients with elevated Lp(a) today.
Original abstract
Lipoprotein(a) (Lp(a)) is a unique low-density lipoprotein-like lipoprotein that is considered an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. The Lp(a) molecule also contains apolipoprotein A and apolipoprotein B, which collectively promote atherosclerosis, thrombosis, and inflammation. Lp(a) is highly genetic and minimally responsive to nonpharmacological measures. Lp(a) serum levels ≥125 nmol/L are associated with increased ASCVD risk, but this threshold has not been accepted universally. Elevated Lp(a) is the most common genetic dyslipidemia affecting approximately 20% of the general population. Certain currently available lipid-lowering drugs, including the proprotein convertase subtilisin/kexin type 9 therapies, produce moderate reductions in Lp(a); however, none are indicated for the treatment of elevated Lp(a). There are currently four investigational RNA-based therapeutic agents that reduce Lp(a) by 70% to 100%. Two of these agents are being evaluated for ASCVD risk reduction in adequately powered outcomes trials, with results expected in 2 to 3 years. Until such therapies become available and demonstrate favorable clinical outcomes, strategies for elevated Lp(a) primarily involve early and intensive ASCVD risk factor management.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.