Lipoprotein(a) and the atherosclerotic burden - Should we wait for clinical trial evidence before taking action?

Area of Science:

• Cardiology
• Genetics
• Epidemiology

Background:

• Lipoprotein(a) is increasingly recognized as a significant independent risk factor for atherosclerotic cardiovascular diseases (ASCVD).
• Elevated lipoprotein(a) levels contribute to residual cardiovascular risk even when other risk factors are managed.
• Understanding the causal role of lipoprotein(a) is crucial for refining cardiovascular risk assessment and management strategies.

Purpose of the Study:

• To review the current evidence supporting the causal link between lipoprotein(a) and ASCVD.
• To discuss potential strategies for reducing lipoprotein(a) levels pending clinical trial outcomes.
• To highlight the clinical utility of measuring lipoprotein(a) for risk stratification.

Main Methods:

• Systematic review of epidemiological and genetic studies.
• Analysis of data on the predictive value of lipoprotein(a) for incident ASCVD.
• Evaluation of current guidelines and recommendations for lipoprotein(a) measurement.

Main Results:

• Robust epidemiological and genetic data confirm a causal relationship between elevated lipoprotein(a) and increased ASCVD risk.
• Lipoprotein(a) levels demonstrate a linear risk gradient across the population distribution.
• Lipoprotein(a) predicts ASCVD events in both primary and secondary prevention settings.

Conclusions:

• Lipoprotein(a) should be considered a causal risk factor for ASCVD.
• Measuring lipoprotein(a) levels is valuable for identifying individuals who could benefit from future lipoprotein(a)-lowering therapies.
• National societies recommend measuring lipoprotein(a) in high-risk individuals and for general risk stratification.