Comprehensive Risk Assessment in the Lipoprotein(a) Landscape: Practical Algorithms for Multi-Modal Risk Stratification
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Mark Steuerwald1, James Underberg2
1Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA. Mark.Steuerwald@nyulangone.org.
Purpose Of Review:
Elevated lipoprotein(a) [Lp(a)] is a common, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Clinicians continue to face questions regarding how overall risk should be refined once Lp(a) is identified.
Recent Findings:
International guidelines are beginning to universally recommend Lp(a) measurement at least once in adulthood, which will make the discovery of elevated Lp(a) a more common finding in routine practice. Despite this, Lp(a) remains absent from conventional risk equations. Additional stratification tools including assessment of subclinical atherosclerosis can be further applied to help distinguish inherited susceptibility from expressed disease. All of this together should support a more informed shared decision regarding the intensity of preventive therapy in these cases. We aim to provide a flexible framework that integrates Lp(a), contemporary risk equations, imaging, and selective genetics to produce actionable risk phenotypes which can guide the intensity of preventive decisions today.
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