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Lipoprotein(a) in clinical practice: What clinicians need to know

Astefanos Al-Dalakta1, Leslie S Cho2, Ashish Sarraju3

  • 1Preventive Cardiology and Cardiac Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.

Cleveland Clinic Journal of Medicine
|November 3, 2025
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] is a key risk factor for cardiovascular disease. New therapies are emerging to lower Lp(a) and reduce associated health risks.

Area of Science:

  • Cardiology
  • Genetics
  • Pharmacology

Background:

  • Elevated lipoprotein(a) [Lp(a)] is a significant, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis (AS).
  • Current standard lipid-lowering therapies demonstrate limited efficacy in reducing Lp(a) levels.
  • Understanding Lp(a) is crucial for cardiovascular risk stratification and management.

Purpose of the Study:

  • To review the current evidence linking elevated Lp(a) to cardiovascular disease risk.
  • To discuss current and emerging screening strategies for identifying individuals with high Lp(a).
  • To summarize the evolving landscape of therapeutic interventions targeting Lp(a).

Main Methods:

  • Literature review of epidemiological studies, genetic research, and clinical trials.
  • Analysis of data on the efficacy of existing and novel lipid-lowering agents on Lp(a).
  • Evaluation of ongoing phase 3 trials assessing cardiovascular outcomes in patients treated for elevated Lp(a).

Main Results:

  • Strong independent association between elevated Lp(a) and increased risk of ASCVD and AS.
  • Limited impact of statins and other conventional therapies on Lp(a) levels.
  • Promising results from emerging therapies, including antisense oligonucleotides and small interfering RNAs, in reducing Lp(a).

Conclusions:

  • Elevated Lp(a) represents a critical unmet need in cardiovascular disease prevention.
  • Targeting Lp(a) with novel therapies holds significant potential for reducing cardiovascular events.
  • Further research and clinical trials are essential to confirm the long-term benefits of Lp(a)-lowering treatments.

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