Guidelines
Reyes-Soffer, Yeang, Michos and Ballantyne argue Lp(a) population screening should start now, ahead of phase 3 apo(a)-lowering trial results (Am J Prev Cardiol 2024)
Original title: High lipoprotein(a): Actionable strategies for risk assessment and mitigation
This review by a multi-institutional group of lipid experts addresses the identification and clinical management of patients with high Lp(a), the most prevalent inherited dyslipidaemia and the strongest genetic ASCVD risk factor, whose risk persists even at guideline-recommended LDL-C targets and with lifestyle adherence. While facets of Lp(a) biology, including its genetics, pathophysiology, and expression across race and ethnic groups, remain incompletely understood, the accumulating epidemiological and genetic evidence for its causal role in ASCVD and calcific aortic stenosis, together with evolving guidelines recommending universal measurement, justifies starting population Lp(a) screening now. The authors note a persistent implementation gap in primary and secondary prevention for high-Lp(a) patients, driven partly by a lack of management protocols, and provide actionable, evidence-based guidance for measuring Lp(a) and mitigating its risk today, even as targeted apo(a)-lowering therapies remain in phase 3 development.
Original abstract
High levels of lipoprotein(a) [Lp(a)] are causal for atherosclerotic cardiovascular disease (ASCVD). Lp(a) is the most prevalent inherited dyslipidemia and strongest genetic ASCVD risk factor. This risk persists in the presence of at target, guideline-recommended, LDL-C levels and adherence to lifestyle modifications. Epidemiological and genetic evidence supporting its causal role in ASCVD and calcific aortic stenosis continues to accumulate, although various facets regarding Lp(a) biology (genetics, pathophysiology, and expression across race/ethnic groups) are not yet fully understood. The evolving nature of clinical guidelines and consensus statements recommending universal measurements of Lp(a) and the scientific data supporting its role in multiple disease states reinforce the clinical merit to start population screening for Lp(a) now. There is a current gap in the implementation of recommendations for primary and secondary cardiovascular disease (CVD) prevention in those with high Lp(a), in part due to a lack of protocols for management strategies. Importantly, targeted apolipoprotein(a) [apo(a)]-lowering therapies that reduce Lp(a) levels in patients with high Lp(a) are in phase 3 clinical development. This review focuses on the identification and clinical management of patients with high Lp(a). Specifically, we highlight the clinical value of measuring Lp(a) and its use in determining Lp(a)-associated CVD risk by providing actionable guidance, based on scientific knowledge, that can be utilized now to mitigate risk caused by high Lp(a).
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.