Related Experiment Video
Updated: Mar 22, 2026
Author Spotlight: Effect of Left Atrial Ligation on Avian Embryonic Hearts and HLHS Implications
Published on: June 16, 2023
JCL Roundtable: Should we treat elevations in Lp(a)?
W Virgil Brown1, Patrick M Moriarty2, Alan T Remaley3
1Emeritus College, Emory University School of Medicine, Atlanta, GA, USA.
Insights
High levels of lipoprotein(a) [Lp(a)] significantly increase vascular disease risk. This discussion addresses challenges in measuring Lp(a) and effective treatments for managing this cardiovascular risk factor.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Clinical Risk Assessment
Background:
- Lipoprotein(a) [Lp(a)] is a significant, yet complex, risk factor for vascular disease.
- Elevated plasma Lp(a) concentrations are linked to increased cardiovascular risk.
- Individual Lp(a) levels are highly variable but stable within a person.
Purpose of the Study:
- To address key clinical questions surrounding lipoprotein(a) [Lp(a)] as a treatment target.
- To clarify measurement methodologies and effective reduction strategies for Lp(a).
- To explore the relationship between Lp(a), low-density lipoprotein-cholesterol (LDL-C), and residual cardiovascular risk.
Main Methods:
- Roundtable discussion format with leading experts in the field.
- Expert panel addressing critical questions on Lp(a) measurement and management.
- Review of current evidence and emerging therapies for Lp(a) reduction.
Main Results:
- Discussion highlights the complexities in obtaining meaningful Lp(a) measurements.
- Exploration of various agents and their effectiveness in lowering Lp(a) levels.
- Consideration of whether Lp(a) reduction directly impacts vascular risk and residual risk after LDL-C lowering.
Conclusions:
- Definitive management strategies for lipoprotein(a) [Lp(a)] remain a clinical challenge.
- Further research is needed to establish optimal Lp(a) targets and effective therapies.
- Understanding the interplay between Lp(a) and LDL-C is crucial for comprehensive cardiovascular risk management.
Abstract:
The focus of this Roundtable discussion is the mysterious lipoprotein Lp(a). There is growing evidence that it confers significant risk of vascular disease at high plasma concentrations. The concentration in plasma is highly variable from person to person but relatively stable in any given individual. The issue of defining this as a target of treatment has many facets, which have stymied clinicians in their management of this risk factor. The pertinent questions are many such as: "How does one obtain the most meaningful measure as there are so many components?" "What agents are truly effective in lowering this lipoprotein particle?" "Does direct treatment with reduction affect risk?" "How does low-density lipoprotein-cholesterol relate to the risk?" "If low-density lipoprotein-cholesterol is reduced, is there residual risk related directly to Lp(a)?" and "Are there effective therapies under development?" For this Roundtable, I am fortunate to have three experts that have studied these questions in various settings and have agreed to answer my questions relevant to these clinical issues. These include Dr Moriarty from the University of Kansas, Dr Remaley from the National Institutes of Health, and Dr Tsimikas from the University of California San Diego.
Related Concept Videos
01:26Atherosclerosis III: Management
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:26Aneurysm III: Interprofessional Care
01:10Pre-Procedural Guidelines for Assessing Blood Pressure