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Published on: October 12, 2017
Lipoprotein(a): An important piece of the ASCVD risk factor puzzle across diverse populations
Nicole Ciffone1, Catherine J McNeal2, Mary P McGowan3,4
1Arizona Center for Advanced Lipidology, 3925 E Fort Lowell Rd, Tucson, AZ 85712, USA.
Insights
Elevated lipoprotein(a) (Lp[a]) is a genetic risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp[a] testing identifies individuals at high risk, enabling personalized cardiovascular disease management and family screening.
Area of Science:
- Cardiology
- Genetics
- Preventive Medicine
Background:
- Elevated lipoprotein(a) (Lp[a]) is a significant genetic risk factor for atherosclerotic cardiovascular disease (ASCVD), affecting approximately 1.4 billion people worldwide.
- Lp[a] levels are genetically determined and stable throughout life, making a single, non-fasting blood test sufficient for lifetime risk assessment.
- Despite its clinical utility, routine Lp[a] testing is underutilized in clinical practice.
Purpose of the Study:
- To review the benefits of lipoprotein(a) testing in identifying and managing cardiovascular disease risk.
- To outline strategies for overcoming barriers to routine Lp(a) testing, such as accessibility and awareness.
- To emphasize the importance of Lp(a) testing as a fundamental component of cardiovascular risk assessment.
Main Methods:
- This review synthesizes current literature on Lp(a) testing, its clinical implications, and practical implementation challenges.
- It examines the role of Lp(a) in risk stratification and its impact on treatment decisions, including statin therapy response.
- The review discusses cascade screening for relatives and strategies to improve testing adoption.
Main Results:
- Lp(a) testing allows for reclassification of ASCVD risk, guiding more intensive management for individuals with elevated levels.
- Identifying elevated Lp(a) can help predict which patients may not respond optimally to statin therapy.
- Cascade screening of family members can uncover genetic cardiovascular risk in relatives of affected individuals.
Conclusions:
- Lipoprotein(a) testing is crucial for identifying individuals at increased genetic risk for ASCVD.
- Routine Lp(a) assessment should be integrated into primary and specialty care to optimize cardiovascular risk management.
- Addressing barriers to testing access and awareness is essential for widespread adoption and improved patient outcomes.
Abstract:
Elevated lipoprotein(a) (Lp[a]) is an independent, genetic risk factor for atherosclerotic cardiovascular disease (ASCVD) that impacts ~1.4 billion people globally. Generally, Lp(a) levels remain stable over time; thus, most individuals need only undergo Lp(a) testing through a non-fasting blood draw once in their lifetime, unless elevated Lp(a) is identified. Despite the convenience of the test for clinicians and patients, routine Lp(a) testing has not been widely adopted. This review provides a guide to the benefits of Lp(a) testing and solutions for overcoming common barriers in practice, including access to testing and lack of awareness. Lp(a) testing provides the opportunity to reclassify ASCVD risk and drive intensive cardiovascular risk factor management in individuals with elevated Lp(a), and to identify patients potentially less likely to respond to statins. Moreover, cascade screening can help to identify elevated Lp(a) in relatives of individuals with a personal or family history of premature ASCVD. Overall, given the profound impact of elevated Lp(a) on cardiovascular risk, Lp(a) testing should be an essential component of risk assessment by primary and specialty care providers.
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