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The dedicated "Lp(a) clinic": A concept whose time has arrived?
Sotirios Tsimikas1, Erik S G Stroes1
1Vascular Medicine Program, Sulpizio Cardiovascular Center, Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
Insights
Elevated lipoprotein(a) [Lp(a)] is a major cause of cardiovascular disease (CVD) and calcific aortic valve disease (CAVD). A dedicated Lp(a) clinic can improve diagnosis and management of this common genetic lipid disorder.
Area of Science:
- Cardiology
- Genetics
- Lipid Metabolism
Background:
- Emerging data confirm lipoprotein(a) [Lp(a)] as a causal factor in cardiovascular disease (CVD) and calcific aortic valve disease (CAVD).
- Novel Lp(a)-lowering therapies have increased clinical focus on this prevalent genetic lipid disorder.
- Over 1.4 billion people globally have Lp(a) levels >50 mg/dL, yet most remain undiagnosed.
Purpose of the Study:
- To highlight the significant, yet under-recognized, role of elevated Lp(a) in various clinical phenotypes of CVD and CAVD.
- To advocate for a new clinical care model: a dedicated "Lp(a) Clinic" for systematic evaluation and management.
- To emphasize the need for multidisciplinary expertise to address Lp(a)-mediated risk.
Main Methods:
- Review of pathophysiological, epidemiologic, and genetic evidence linking Lp(a) to CVD and CAVD.
- Discussion of current and emerging Lp(a)-lowering treatment strategies.
- Proposal for a specialized outpatient clinic model for patients with elevated Lp(a).
Main Results:
- Elevated Lp(a) is associated with a spectrum of atherothrombotic risks, from pediatric stroke to myocardial infarction in young men and CAVD in the elderly.
- Patients with elevated Lp(a) are significantly under-diagnosed, with diagnoses often made incidentally.
- A systematic approach is needed to identify and manage individuals at risk due to high Lp(a).
Conclusions:
- The strong evidence for Lp(a) causality in CVD and CAVD necessitates improved diagnostic and management strategies.
- A dedicated "Lp(a) Clinic" offers a paradigm shift for comprehensive patient care, integrating lipidology, cardiology, and other specialties.
- Establishing such clinics can effectively reduce the burden of Lp(a)-mediated cardiovascular and valvular diseases.
Abstract:
The emergence of pathophysiological, epidemiologic, and genetic data strongly supports the causality for lipoprotein(a) [Lp(a)] in cardiovascular disease (CVD) and calcific aortic valve disease (CAVD). In parallel, novel Lp(a) lowering approaches have been developed that have re-invigorated clinical interest in Lp(a). Because Lp(a) is the most prevalent monogenetic lipid disorder globally, with prevalence of Lp(a) > 50 mg/dL estimated at >1.4 billion people, the rationale for diagnosing and managing Lp(a)-mediated risk is now stronger than ever. Patients with elevated Lp(a) are significantly under-diagnosed and the diagnosis is frequently made ad hoc rather than systematically. Elevated Lp(a) levels are associated with atherothrombotic risk and patients present with varied clinical phenotypes, ranging from stroke in pediatric age groups, to ST-segment elevation myocardial infarction in young males, to CAVD in elderly individuals. A new clinical care paradigm of a dedicated "Lp(a) Clinic" would serve to evaluate and manage such patients who have elevated Lp(a) as the pathophysiological etiology. Such a clinic would include multidisciplinary expertise in lipid metabolism, clinical cardiology, vascular medicine, valvular disease, thrombosis, and pediatric aspects of clinical care. This viewpoint argues for the rationale of an Lp(a) outpatient clinic where patients with elevated Lp(a) and their affected relatives can be referred, evaluated, managed and followed, to ultimately reduce Lp(a)-mediated CVD and CAVD risk.
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