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Evolving guidelines on lipoprotein(a)
Michael B Boffa1,2, Marlys L Koschinsky1,3, Robert A Hegele1,2,4
1Robarts Research Institute.
Insights
Elevated lipoprotein(a) [Lp(a)] is a key risk for cardiovascular disease. Guidelines now suggest universal Lp(a) screening and incorporating levels into prevention strategies, though more research is needed.
Area of Science:
- Cardiology
- Atherosclerosis Research
- Lipidology
Background:
- Elevated plasma lipoprotein(a) [Lp(a)] is a recognized causal risk factor for atherosclerotic cardiovascular disease.
- Lp(a) has emerged as a significant therapeutic target in cardiovascular risk management.
Purpose of the Study:
- To review the evolution of scientific statements and clinical guidelines concerning Lp(a) over the past 15 years.
- To track changes in recommendations for Lp(a) management and screening.
Main Methods:
- Systematic review of global medical body statements and clinical guidelines published over the last 15 years.
- Analysis of evolving recommendations regarding Lp(a) levels and cardiovascular disease risk.
Main Results:
- Studies increasingly demonstrate Lp(a)'s independent association with cardiovascular disease, enabling refined risk stratification.
- Guidelines now advocate for universal Lp(a) screening and consider it a risk-enhancing factor in primary prevention.
- Gaps and inconsistencies in current recommendations persist despite growing evidence.
Conclusions:
- Consensus is growing for routine Lp(a) measurement in all adults and its integration into cardiovascular disease prevention decision-making.
- Future cardiovascular outcomes trials of Lp(a)-lowering therapies will shape clinical practice.
- Caution is advised due to remaining gaps in the evidence base supporting current consensus.
Purpose Of Review:
Elevated plasma lipoprotein(a) [Lp(a)] is a causal and independent risk factor for atherosclerotic cardiovascular disease and an emerging therapeutic target. Over the past 15 years, many medical bodies from around the world have released scientific statements and clinical guidelines regarding Lp(a). This review tracks how recommendations on Lp(a) have evolved over this timeframe.
Recent Findings:
Powerful studies demonstrating the independent association of elevated Lp(a) in large numbers of patients have been published. The data allowed a more precise formulation of risk categories for Lp(a) levels and of models for how a given level of Lp(a) in a moderate-risk to high-risk primary prevention patient might inform management of modifiable risk factors such as LDL cholesterol. Guidelines and statements have increasingly recommended universal screening for elevated Lp(a) and have identified elevated Lp(a) as a risk-enhancing or amplifying factor. However, some gaps and inconsistencies remain.
Summary:
Ongoing cardiovascular outcomes trials of potent Lp(a)-lowering therapies will inform clinical use of Lp(a) in the future. Presently, consensus is building for measurement of Lp(a) in all adults and for incorporation of Lp(a) levels into clinical decision-making for prevention of cardiovascular disease. However, caution is warranted as the evidence base underlying this consensus has several important missing pieces.
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