Guidelines
Review argues Lp(a) testing and risk-based management should not wait for outcome-trial results (Atheroscler Plus 2024)
Original title: Lipoprotein(a) and the atherosclerotic burden - Should we wait for clinical trial evidence before taking action?
This review summarises epidemiological and genetic evidence establishing Lp(a) as a causal, residual risk factor for atherosclerotic cardiovascular disease (ASCVD), predicting incident events in both primary and secondary prevention with a linear risk gradient across its distribution. Framing the central question as whether clinicians must wait for dedicated outcome trials of Lp(a)-lowering drugs before acting, the authors argue that measuring Lp(a) now can already identify patients likely to benefit later from emerging Lp(a)-lowering therapies. The review notes this reasoning underpins multiple national societies' recommendations to measure Lp(a) in high-risk individuals, and more broadly at least once in every adult, for cardiovascular risk stratification ahead of trial results.
Original abstract
The fact that lipoprotein(a) levels should be regarded as a causal residual risk factor in the atherosclerotic cardiovascular diseases (ASCVD) is now a no-brainer. This review article aims to summarize the latest evidence supporting the causal role of lipoprotein(a) in ASCVD and the potential strategies to reduce the lipoprotein(a) burden until clinical trial results are available. Epidemiological and genetic data demonstrate the causal link between lipoprotein(a) and increased ASCVD risk. That being said, a specific question comes to mind: "must we wait for outcome trials in order to take action?". Given that lipoprotein(a) levels predict incident ASCVD in both primary and secondary prevention contexts, with a linear risk gradient across its distribution, measuring lipoprotein(a) can unequivocally help identify patients who may later benefit from specific lipoprotein(a)-lowering therapies. This understanding has led various National Societies to recommend dosing lipoprotein(a) in high-risk individuals and to support the recommendation of measuring lipoprotein(a) levels at least once in every adult for risk stratification.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.