The dedicated "Lp(a) clinic": A concept whose time has arrived?

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.