Guidelines
Review consolidates the case for Lp(a) as a causal driver of ASCVD and aortic valve stenosis behind three major guideline bodies (Curr Cardiovasc Risk Rep 2025)
Original title: Lipoprotein(a) as a Causal Risk Factor for Cardiovascular Disease
This review summarises evidence that Lp(a), roughly 90% genetically determined and elevated in about 20% of the global population, is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS). Epidemiological, genome-wide association, Mendelian randomisation and meta-analysis data consistently link Lp(a) to ASCVD and CAVS, with emerging but weaker evidence for associations with ischaemic stroke, peripheral arterial disease, and heart failure. The review notes that the 2024 National Lipid Association, 2022 European Atherosclerosis Society, and 2021 Canadian Cardiovascular Society guidelines all now recommend testing Lp(a) once in every adult to guide primary prevention, and identifies cardiovascular outcome trials of Lp(a)-targeted therapies as the next step needed to close the causal loop.
Original abstract
Purpose Of Review: Lipoprotein(a) [Lp(a)], an atherogenic low-density lipoprotein cholesterol (LDL-C)-like molecule, has emerged as an important risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). This review summarizes the evidence supporting Lp(a) as a causal risk factor for ASCVD and calcific aortic valve stenosis (CAVS).
Recent Findings: Lp(a) is largely (~ 90%) genetically determined and approximately 20% of the global population has elevated Lp(a). The unique structure of Lp(a) leads to proatherogenic, proinflammatory, and antifibrinolytic properties. Data from epidemiological, genome-wide association, Mendelian randomization, and meta-analyses have shown a clear association between Lp(a) and ASCVD, as well as CAVS. There are emerging data on the association between Lp(a) and ischemic stroke, peripheral arterial disease, and heart failure; however, the associations are not as strong.
Summary: Several lines of evidence support Lp(a) as a causal risk factor for ASCVD and CAVS. The 2024 National Lipid Association guidelines, 2022 European Atherosclerosis Society, and 2021 Canadian Cardiology Society guidelines recommend testing Lp(a) once in all adults to guide primary prevention efforts. Further studies on cardiovascular outcomes with Lp(a) targeted therapies will provide more insight on causal relationship between Lp(a) and cardiovascular disease.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.