Testing
Fifteen years of Lp(a) guidelines have moved toward universal screening, but important evidence gaps remain, Boffa, Koschinsky and Hegele find (Curr Opin Lipidol 2025)
Original title: Evolving guidelines on lipoprotein(a)
This review by Boffa, Koschinsky and Hegele tracks how clinical guidelines and scientific statements on lipoprotein(a) from medical bodies worldwide have evolved over the past 15 years. Powerful studies demonstrating Lp(a)'s independent association with atherosclerotic cardiovascular disease in large patient populations have allowed more precise risk categories and models for how a given Lp(a) level should inform management of modifiable risk factors like LDL cholesterol in moderate- to high-risk primary prevention patients. Guidelines and statements have increasingly recommended universal screening for elevated Lp(a) and identified it as a risk-enhancing or amplifying factor, though the authors note gaps and inconsistencies remain across bodies. They conclude that consensus is building for measuring Lp(a) in all adults and incorporating it into clinical decision-making, but caution the underlying evidence base still has important missing pieces pending ongoing outcomes trials.
Original abstract
Purpose Of Review: Elevated plasma lipoprotein(a) [Lp(a)] is a causal and independent risk factor for atherosclerotic cardiovascular disease and an emerging therapeutic target. Over the past 15 years, many medical bodies from around the world have released scientific statements and clinical guidelines regarding Lp(a). This review tracks how recommendations on Lp(a) have evolved over this timeframe.
Recent Findings: Powerful studies demonstrating the independent association of elevated Lp(a) in large numbers of patients have been published. The data allowed a more precise formulation of risk categories for Lp(a) levels and of models for how a given level of Lp(a) in a moderate-risk to high-risk primary prevention patient might inform management of modifiable risk factors such as LDL cholesterol. Guidelines and statements have increasingly recommended universal screening for elevated Lp(a) and have identified elevated Lp(a) as a risk-enhancing or amplifying factor. However, some gaps and inconsistencies remain.
Summary: Ongoing cardiovascular outcomes trials of potent Lp(a)-lowering therapies will inform clinical use of Lp(a) in the future. Presently, consensus is building for measurement of Lp(a) in all adults and for incorporation of Lp(a) levels into clinical decision-making for prevention of cardiovascular disease. However, caution is warranted as the evidence base underlying this consensus has several important missing pieces.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.