From the Guidelines
The primary purpose of the Lipoprotein(a) (Lp(a)) test is to identify patients at high risk of cardiovascular disease (CVD) who may benefit from more intensive management of treatable risk factors, particularly LDL cholesterol, with a target level of Lp(a) below 50 mg/dL. The Lp(a) test measures the level of Lipoprotein(a), a constituent of apolipoprotein(a) [Apo(a)] bound to apolipoprotein B-100, in the blood. According to the European Society of Cardiology (ESC) guidelines, Lp(a) measurement is recommended in patients at high risk of CVD, including those with premature CVD, premature stroke, and intermediate risk groups when classical risk algorithms are used 1. Some key patient groups that may benefit from Lp(a) measurement include:
- Patients with premature CVD and premature stroke
- Patients in an intermediate risk group when classical risk algorithms are used
- Patients with recurrent or rapidly progressive vascular disease despite being on lipid-lowering medication
- Patients with familial hypercholesterolemia (FH) or other forms of genetic dyslipidaemias
- Patients with low HDL-C, genetic defects related to haemostasis and homocysteine, diabetes, and auto-immune diseases
- Haemodialysis patients and patients with renal disease, as Lp(a) levels are often elevated in these conditions. If Lp(a) is found to be elevated, the most important next step is to treat traditional modifiable risk factors such as LDL cholesterol, hypertension, smoking, diabetes, and obesity intensively, with consideration of additional treatments like niacin and LDL apheresis in selected patients 1.
From the Research
Purpose of the Lipoprotein(a) (Lp(a)) Test
The Lipoprotein(a) (Lp(a)) test is used to measure the level of Lp(a) in the blood, which is a risk factor for cardiovascular disease [ 2, 3, 4, 5, 6 ]. The test is used to:
- Identify individuals with elevated Lp(a) levels, which is associated with an increased risk of cardiovascular disease [ 2, 5 ]
- Assess the risk of cardiovascular disease in individuals with a personal or family history of cardiovascular disease [ 3, 4 ]
- Monitor the effectiveness of treatments aimed at reducing Lp(a) levels [ 6 ]
Key Findings
- Elevated Lp(a) levels are associated with an increased risk of cardiovascular disease, including atherosclerotic cardiovascular disease and calcific aortic valve stenosis [ 2, 5, 6 ]
- Lp(a) levels are not affected by lifestyle modifications, statins, or ezetimibe, but can be reduced with proprotein convertase subtilisin/kexin type 9 inhibitors and emerging nucleic acid-based therapies [ 2, 6 ]
- The Lp(a) test can be used to guide medical care and shared decision-making in individuals with elevated Lp(a) levels [ 3 ]
Clinical Applications
- The Lp(a) test can be used to identify individuals who may benefit from aggressive management of traditional cardiovascular risk factors, including LDL-cholesterol [ 3, 4 ]
- The test can also be used to monitor the effectiveness of treatments aimed at reducing Lp(a) levels and cardiovascular risk [ 6 ]