Clinical Care for Patients With Elevated Lipoprotein(a) Level in Canada: A Practical Framework for Screening, Risk...

Area of Science:

• Cardiology
• Genetics
• Preventive Medicine

Background:

• Lipoprotein(a) [Lp(a)] is a significant, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic stenosis (AS).
• Despite affecting 20% of Canadians, Lp(a) is under-recognized and under-measured in clinical practice.
• Existing cardiovascular risk calculators often omit Lp(a), limiting accurate risk assessment.

Purpose of the Study:

• To provide guidance on assessing and managing Lp(a) for primary and secondary prevention in Canada.
• To recommend universal, one-time Lp(a) testing in adulthood.
• To support clinicians in early identification and risk reduction for individuals with elevated Lp(a).

Main Methods:

• Review of the pathophysiologic role of Lp(a) in atherosclerosis, thrombosis, and AS.
• Analysis of ethnic variability in Lp(a) levels and associated risks.
• Discussion of emerging imaging and novel Lp(a)-lowering therapies.

Main Results:

• Lp(a) promotes atherosclerosis, thrombosis, and AS.
• Significant ethnic variations exist in Lp(a) levels and risk.
• Current management focuses on preventive interventions while awaiting targeted therapies.

Conclusions:

• Universal Lp(a) testing is recommended for early identification of ASCVD and AS risk.
• Clinicians need guidance on interpreting Lp(a) values and implementing preventive strategies.
• Addressing Lp(a) is crucial for comprehensive cardiovascular risk management.