Lipoprotein (a) in primary cardiovascular disease prevention is actionable today

Lipoprotein(a) [Lp(a)] has emerged as an important, genetically determined, and independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease. Despite growing evidence of its causal role in cardiovascular morbidity and mortality, its actionability in primary prevention remains underrecognized. This review highlights the contemporary scientific foundation supporting early Lp(a) measurement, elucidates its pathogenic mechanisms, evaluates the evolving therapeutic landscape, and proposes a pragmatic clinical framework for integrating Lp(a) into preventive cardiology today. Through clinical vignettes and current data, we argue that identifying elevated Lp(a) can meaningfully guide risk reclassification, intensify modifiable risk management, and inform patient-centered preventive strategies thereby making Lp(a) testing actionable in contemporary primary prevention.