From the Guidelines
Lipoprotein(a) (Lp(a)) is a significant risk factor for cardiovascular disease (CVD) and should be measured in patients at high risk, with a target level below 50 mg/dL. The European Society of Cardiology (ESC) guidelines recommend measuring Lp(a) in patients at high risk of CVD, as it has been shown to have pro-atherogenic and pro-thrombotic properties 1. Several observational studies and meta-analyses have found a causal association between Lp(a) levels and CVD events, including emergent outcomes in the elderly, such as heart failure and calcific aortic valve stenosis.
Key Points
- Lp(a) levels are mainly determined by genetic traits, but can also be influenced by other factors such as diet and lifestyle.
- Elevated Lp(a) levels have been associated with an increased risk of coronary artery disease, stroke, and other CVD events 1.
- The addition of information on Lp(a) to conventional risk factors can improve the prediction of cardiovascular events and may lead to more accurate risk assessment and treatment decisions.
- Niacin has been shown to decrease Lp(a) levels, but its effect on stroke risk is unclear, with some studies suggesting a potential benefit while others have found no significant effect 1.
Clinical Implications
- Measuring Lp(a) levels can help identify patients at high risk of CVD who may benefit from more aggressive treatment and lifestyle modifications.
- Targeting Lp(a) levels below 50 mg/dL may help reduce the risk of CVD events, particularly in patients with elevated levels.
- Further research is needed to fully understand the relationship between Lp(a) and CVD, as well as the potential benefits and risks of Lp(a)-lowering therapies.
From the Research
Significance of Lipoprotein(a) to Health
- Lipoprotein(a) [Lp(a)] is a molecule that induces inflammation of the blood vessels, atherogenesis, valvular calcification, and thrombosis 2.
- High Lp(a) levels are associated with a persisting risk for atherosclerotic cardiovascular diseases despite optimization of established risk factors, including low-density lipoprotein cholesterol (LDL-C) levels 2, 3.
- Approximately a quarter of the world population have Lp(a) levels of >50 mg/dL (125 nmol/L), a level associated with elevated cardiovascular risk 2.
Association with Cardiovascular Disease
- Lp(a) is an established risk factor for multiple cardiovascular diseases, including atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis/calcific aortic valve disease (AS/CAVD) 3, 4.
- Elevated Lp(a) is independently associated with long-term major adverse cardiovascular events (MACE) among individuals with and without baseline ASCVD 4.
- Lp(a) has proatherogenic, prothrombotic, and pro-inflammatory roles, contributing to the atherosclerotic process 5, 6.
Treatment Options
- Current lipid-lowering drugs have limited effects on Lp(a) levels, but emerging therapies targeting Lp(a) may offer the possibility to further investigate the relation between Lp(a) levels and cardiovascular outcomes 2, 5.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can effectively decrease Lp(a) levels, but their effects are not purely through Lp(a) reduction 6.
- Gene-based therapies that affect transcription and translation of apolipoprotein(a) mRNA are being developed as potential treatment options for patients with high Lp(a) levels 6.