Japanese expert consensus establishes Lp(a) risk thresholds at 25 and 125 nmol/L (J Atheroscler Thromb 2026)

Lipoprotein(a) [Lp(a)] is a genetically determined causal factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS). Although international societies have issued various guidelines, Japan requires a framework that incorporates domestic epidemiology, clinical practice, and evolving laboratory standardization. Recent Japanese evidence-including the LEAP Study-confirms that while median Lp(a) levels in Japan are lower than in Western populations, individuals with elevated concentrations (particularly ≥ 125 nmol/L) face substantial incremental ASCVD and CAVS risk.This consensus provides Japan-specific recommendations for Lp(a) measurement, risk thresholds, interpretation, and management. We propose three pragmatic risk categories based on nmol/L: low (＜25 nmol/L), intermediate (≥ 25 to ＜125 nmol/L), and high (≥ 125 nmol/L). While standardized nmol/L reporting is not yet available in Japan, the clinical significance of standardization is increasingly recognized, and the adoption of International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)-aligned assays is expanding. Lp(a) should be measured at least once in adulthood, with an emphasis on high-risk groups, including familial hypercholesterolemia (FH), premature ASCVD families, and patients with recurrent cardiovascular events.Management focuses on aggressive low-density lipoprotein cholesterol (LDL-C) lowering and optimization of modifiable risk factors. Emerging Lp(a)-specific therapies, including pelacarsen, olpasiran, muvalaplin, and SLN360, demonstrate up to 80-95% reductions in Lp(a) and may redefine care once outcome trial data (e.g., HORIZON) become available.Finally, we outline the implementation priorities for Japan, emphasizing improved measurement access, laboratory harmonization, public and professional education, and the integration of Lp(a) into existing clinical pathways and research infrastructures. This consensus statement is intended to support clinicians, researchers, and policymakers in reducing the residual ASCVD risk attributable to Lp(a) in Japan.