What the societies say, in date order, newest first. The common ground since 2019: measure Lp(a) at least once in every adult, treat it as a risk modifier, intensify everything else while the outcomes trials read out.
American College of Cardiology / American Heart Association and nine partner societies2026
Blumenthal, Morris and the writing committee, Circulation and JACC 2026. Retires the 2018 blood cholesterol guideline; scope now explicitly includes hypertriglyceridemia and elevated lipoprotein(a); moves the US toward universal once-in-a-lifetime Lp(a) measurement and its use as a risk enhancer, in line with the NLA 2024 update. Leslie Cho's top-10 talk (Video) is the fastest orientation.
Presented at ESC Congress 2025 (Madrid); Mach, Koskinas, Roeters van Lennep and colleagues, European Heart Journal 2025. Revises the LDL-C pathway around earlier combination therapy and keeps lipoprotein(a) as a once-in-a-lifetime measurement and risk modifier, noting that outcomes evidence for specific Lp(a) lowering is still awaited. See the two ESC 2025 videos in Video.
From the Lp(a) Global Summit in Brussels, 24 to 25 March 2025: integrate Lp(a) testing into cardiovascular health plans, invest on the strength of cost-saving analyses, mandate once-in-a-lifetime testing with reimbursement, and raise awareness. Testing rates today: 1 to 2 percent.
Koschinsky, Bajaj, Boffa and colleagues, Journal of Clinical Lipidology 2024: measure Lp(a) at least once in every adult; below 75 nmol/L (30 mg/dL) low risk, 75 to 125 intermediate, 125 nmol/L (50 mg/dL) or more high; cascade screening of first-degree relatives; early intensive risk-factor management; apheresis for the approved indication.
Kronenberg, Mora, Stroes and colleagues, European Heart Journal 2022: Lp(a) is a causal, continuous risk factor across ethnicities and at very low LDL-C; measure at least once in every adult; cascade testing in FH or with (very) high Lp(a) or premature ASCVD in the family; intensify management of all other risk factors according to global risk and Lp(a) level; apheresis for the extreme case; a lifetime-risk…
Reyes-Soffer, Ginsberg, Berglund and colleagues, ATVB 2022: the biology, pathophysiology and clinical evidence, and the gaps in assay standardisation, testing guidance and therapy that the 2024 to 2026 documents began to close.
Pearson, Thanassoulis, Anderson and colleagues: Lp(a) once in a lifetime as part of initial lipid screening; non-HDL-C or apoB preferred when triglycerides exceed 1.5 mmol/L; coronary calcium as a decision tool.
Cegla, Neely, France and colleagues, Atherosclerosis 2019: whom to test (premature ASCVD, relatives with Lp(a) above 200 nmol/L, FH, calcific aortic stenosis, borderline risk), a 90 to 200 nmol/L risk gradient, non-HDL-C below 2.5 mmol/L and apheresis for selected patients.
Mach, Baigent, Catapano and colleagues: the first major guideline to recommend Lp(a) measurement at least once in every adult's lifetime, to identify very high inherited levels (above 180 mg/dL, about 430 nmol/L) equivalent in lifetime risk to heterozygous FH.
Nordestgaard, Chapman, Ray and colleagues, European Heart Journal 2010: the document that set the 50 mg/dL (80th percentile) desirable level and the first testing recommendations, in the niacin and apheresis era.