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Lp(a): A potentially modifiable cardiovascular risk factor

Daniel E Hilleman1, James M Backes2

  • 1Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|April 9, 2026
PubMed

Insights

Elevated lipoprotein(a) (Lp(a)) is a genetic risk factor for cardiovascular disease. New therapies show promise in significantly reducing Lp(a) levels, but current management focuses on intensive risk factor control.

Area of Science:

  • Cardiovascular Medicine
  • Lipidology
  • Genetics

Background:

  • Lipoprotein(a) (Lp(a)) is a lipoprotein particle implicated in cardiovascular disease.
  • Elevated Lp(a) is a genetically determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis (CAVS).

Purpose of the Study:

  • To review the pathophysiology, epidemiology, clinical assessment, and management strategies for elevated Lp(a) levels.
  • To discuss the role of Lp(a) in ASCVD and CAVS.
  • To highlight emerging therapeutic targets for Lp(a).

Main Methods:

  • Literature review of existing studies on Lp(a).
  • Analysis of the molecular structure and atherogenic properties of Lp(a).
  • Evaluation of current and investigational treatment approaches for elevated Lp(a).

Main Results:

  • Lp(a) combines LDL's cholesterol content with apo(a)'s inflammatory properties, promoting atherosclerosis.
  • Standard lipid-lowering drugs have minimal impact on Lp(a) levels.
  • Investigational agents targeting Lp(a) synthesis or binding demonstrate significant reductions (80-100%) in clinical trials.

Conclusions:

  • Elevated Lp(a) is a causal risk factor for ASCVD and CAVS, contributing to mortality.
  • While novel therapies show high efficacy in lowering Lp(a), their clinical outcome benefits are pending.
  • Current management emphasizes aggressive ASCVD risk factor modification in patients with high Lp(a).
Abstract

Keywords:
atherosclerotic cardiovascular diseasecalcific aortic valve diseasecholesterollipoprotein(a)low-density lipoprotein

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