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Rationale for the Routine Screening of Lipoprotein (a) in Cardiovascular Risk Assessment
Iulia Iatan1,2, Marlys L Koschinsky3, Logan Trenaman4,5
1Department of Medicine.
Insights
Lipoprotein(a) [Lp(a)] testing is recommended for cardiovascular disease screening. Measuring Lp(a) meets criteria for routine screening, aiding proactive prevention and healthcare savings.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
- Preventive Cardiology
Background:
- Lipoprotein(a) [Lp(a)] is causally linked to atherosclerotic cardiovascular disease and aortic stenosis.
- Elevated Lp(a) poses a cardiovascular risk comparable to untreated familial hypercholesterolemia.
- Historically, Lp(a) measurement has not been routine in cardiovascular risk assessment.
Purpose of the Study:
- To evaluate Lp(a) measurement against established criteria for population screening.
- To assess the health, societal, and cost-effectiveness of routine Lp(a) screening.
- To support the integration of Lp(a) into cardiovascular risk management strategies.
Main Methods:
- Review of established principles for population screening analyte selection.
- Assessment of Lp(a) measurement against health, societal, and economic criteria.
- Analysis of current European, Canadian, and National Lipid Association guidelines.
Main Results:
- Lp(a) measurement aligns with the majority of recommended principles for a population screening test.
- Screening for Lp(a) is now recommended by major European, Canadian, and US lipid guidelines.
- Incorporating Lp(a) assessment supports proactive preventive medicine and healthcare system savings.
Conclusions:
- Routine Lp(a) screening is supported by scientific evidence and clinical guidelines.
- Widespread Lp(a) measurement can enhance cardiovascular disease prevention strategies.
- Integrating Lp(a) into risk assessment offers significant health and economic benefits.
Abstract:
Lipoprotein(a) [Lp(a)] is a lipid particle identified by Mendelian randomization studies to be causally associated with the development of atherosclerotic cardiovascular disease and aortic stenosis, across ethnicities. The risk of cardiovascular disease with markedly elevated Lp(a) is equal to that of untreated familial hypercholesterolemia, and yet, up until now, there has been hesitancy in measuring Lp(a) as a routine part of cardiovascular risk assessment. Screening of Lp(a) level in all individuals is now recommended in the European and Canadian Lipid Guidelines and by the National Lipid Association. This review assesses how well measurement of Lp(a) meets accepted criteria for population screening of an analyte, based on established principles used for the selection of a new candidate for inclusion in screening programs. Lp(a) meets the majority of recommended principles for a routine population screening test, based on health, societal, and cost considerations. Incorporating Lp(a) into global assessment and management of cardiovascular risk will result in savings to health care systems, reinforce recommendations from growing numbers of clinical guidelines and consensus statements, and increase implementation of proactive preventive medicine.
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