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Amsterdam UMC case-based review argues interventional cardiologists should measure Lp(a) routinely, given liberal but under-used guideline endorsement (Expert Rev Cardiovasc Ther 2024)
Original title: Lipoprotein(a) in interventional cardiology: identifying patients at highest risk of recurrent cardiovascular events through early recognition - a case based review
This case-based narrative review, grounded in AHA and EAS expert consensus statements plus recent 2023-2024 literature, presents four clinical cases of patients with elevated Lp(a) to illustrate its pathophysiological impact on coronary artery disease encountered in interventional cardiology. Despite a liberal guideline recommendation to measure Lp(a) (Class IIa, Level C), the authors argue this likely translates into underuse by interventional cardiologists in practice. They emphasise that knowing a patient's Lp(a) level helps identify who carries the highest residual atherosclerotic risk, warranting more potent pharmacological treatment and closer attention during catheter-based interventions. As advanced intravascular imaging and diagnostics increasingly integrate into catheterisation laboratories, the authors argue Lp(a) status will become still more central to tailoring patient care, and until dedicated Lp(a)-lowering drugs complete their ongoing trials, aggressive management of other modifiable risk factors remains essential in these patients.
Original abstract
Introduction: Lipoprotein(a) [Lp(a)] is linked to higher risks of atherosclerotic cardiovascular disease (ASCVD). Current guideline recommendations are quite liberal on measuring Lp(a) (Class IIa, Level C), and may lead to underuse among (interventional) cardiologists.
Areas Covered: This case-based narrative review outlines four clinical cases of patients with elevated Lp(a) to illustrate its pathophysiological impact on coronary artery disease (CAD). The expert consensus statements from the American Heart Association (AHA) and European Atherosclerosis Society (EAS) served as the basis of this review. More recent publications, from 2023 to 2024, were accessed through the MEDLINE online library.
Expert Opinion: We highlighted the importance of routine Lp(a) measurement in identifying patients at high risk for atherosclerosis, necessitating potent risk mitigation. Measuring Lp(a) helps clinicians identify which patients are at highest residual risk, who require potent pharmacological treatment and special attention during catheter interventions. As noninvasive and advanced intravascular imaging modalities evolve, future catheterization laboratories will integrate advanced imaging, diagnostics, and treatment, facilitating tailored patient care. Knowing Lp(a) levels is crucial in this context. While Lp(a)-lowering drugs are currently investigated in clinical trials, it is of paramount importance to know Lp(a) levels and strive toward aggressive management of other modifiable risk factors in patients with elevated Lp(a) and established symptomatic CAD being diagnosed or treated in catheterization laboratories.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.