[Lipoprotein(a) - the hereditary risk factor for cardiovascular disease]

Lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis. The level is genetically determined and remains stable during life, and elevated levels may be inherited. The 2025 ESC/EAS Management of Dyslipidaemias Focused Update recommends measuring Lp(a) at least once in adulthood. It further recommends considering Lp(a) >105 nmol/L (>50 mg/dL) as a risk-enhancing factor to refine risk classification, particularly near treatment thresholds. In Sweden, an estimated 10-20 procent of the population (1-2 million people) exceed the 105 nmol/L or 50 mg/dL threshold, hundreds of thousands of whom may be reclassified as being eligible for primary preventive treatment, according to the updated guidelines. While specific Lp(a)-lowering therapies are not yet available, individuals with elevated Lp(a) should receive intensified management of traditional risk factors, primarily lower LDL cholesterol. Scalable approaches are needed to identify and follow high-risk individuals without overburdening primary care.