Guidelines
Review argues an elevated Lp(a) is actionable today, through LDL-C control, PCSK9 inhibitors and aspirin, not just future dedicated drugs (Curr Opin Lipidol 2024)
Original title: Strategies for management of patients with elevated lipoprotein(a)
This review addresses a commonly cited barrier to wider Lp(a) testing, uncertainty about what to do once an elevated result is found, despite growing evidence supporting testing and guideline agreement that Lp(a) should function as a risk enhancer guiding care and shared decision-making. The cornerstone of management, the authors argue, is aggressive control of traditional risk factors, especially LDL-C, which can be incorporated into existing risk stratification frameworks once Lp(a) is known to be elevated. Recent studies highlighted include a potential role for PCSK9 inhibitors, aspirin in primary prevention, and prolonged dual antiplatelet therapy in secondary prevention specifically in patients with elevated Lp(a). The review concludes that while dedicated Lp(a)-targeted therapies remain in development, elevated Lp(a) is already actionable today, and this uncertainty should not be used to justify continued under-testing.
Original abstract
Purpose Of Review: There is growing literature that supports the testing of Lp(a). However, few patients are tested, including those with a personal or family history of cardiovascular disease (CVD). One often noted barrier to more widespread testing is uncertainty regarding what to do with an elevated Lp(a) level. Although guidelines vary, there is agreement on the use of Lp(a) as a risk enhancer to guide medical care and shared decision-making. This review will discuss a clinical approach with supporting evidence for management of patients with elevated Lp(a).
Recent Findings: At the minimum, elevated Lp(a) increases cardiovascular risk and can be incorporated into existing risk stratification paradigms. The cornerstone of management is aggressive management of traditional cardiovascular risk factors, including LDL-cholesterol (LDL-C). More recent studies have highlighted the potential role for proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), aspirin in primary prevention, and prolonged dual antiplatelet therapy in secondary prevention.
Summary: Although there is optimism for Lp(a)-targeted therapies in the near future, an elevated Lp(a) level is actionable today, and uncertainty regarding the management of patients with elevated Lp(a) should not be a barrier to more widespread testing.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.