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Is Lipoprotein(a) Clinically Actionable with Today's Evidence? The Answer is Yes
Gary S Ma1, Tommy T Chiou1, Michael J Wilkinson2
1Division of Cardiovascular Medicine, Department of Medicine, Cardiovascular Institute, UC San Diego Health, Sulpizio Cardiovascular Center, University of California San Diego, 9434 Medical Center Dr, MC 7241, La Jolla, CA, 92037, San Diego, USA.
Current Cardiology Reports
|August 26, 2023
Summary
Elevated Lipoprotein(a) [Lp(a)] is a key cardiovascular disease risk factor. Current guidelines and evidence confirm that Lp(a) testing is clinically actionable for risk stratification and guiding therapy.
Area of Science:
- Cardiovascular Medicine
- Clinical Genetics
- Biochemistry
Background:
- Lipoprotein(a) [Lp(a)] is recognized as an independent risk factor for various cardiovascular diseases (CVD).
- Understanding Lp(a)'s role is crucial for effective CVD prevention strategies.
Purpose of the Study:
- To review evolving consensus guidelines for Lp(a) testing and management.
- To assess the clinical actionability of Lp(a) awareness and testing based on current evidence.
Main Methods:
- Review of genetic studies (GWAS, Mendelian randomization) establishing causal links between Lp(a) and CVD.
- Analysis of evidence from non-targeted and targeted therapies affecting Lp(a) levels.
- Evaluation of Lp(a) testing for risk stratification and cascade screening.
Main Results:
- Elevated Lp(a) is causally linked to coronary artery disease and calcific aortic valve disease.
- Lp(a) testing aids risk stratification, identifies individuals at high risk comparable to heterozygous familial hypercholesterolemia, and facilitates cascade screening.
- Therapies reducing Lp(a) (e.g., PCSK9 inhibition, apheresis) show reductions in atherosclerotic cardiovascular disease (ASCVD) risk.
Conclusions:
- Lipoprotein(a) testing is clinically actionable for identifying high-risk patients for primary and secondary ASCVD prevention.
- Lp(a) levels can guide therapy intensification and inform cascade screening in families with a history of elevated Lp(a).
- Targeted therapies to lower Lp(a) are in development, further enhancing its clinical utility.
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