From the Guidelines
Elevated Lipoprotein(a) (Lp(a)) levels are a significant risk factor for cardiovascular disease (CVD) and calcific aortic valve disease (CAVD).
Key Points
- Lp(a) levels in the atherothrombotic range are generally accepted as >30–50 mg/dL or >75–125 nmol/L 1
- Elevated Lp(a) levels affect 20–30% of the global population, with possibly higher incidence in patients with established CVD and CAVD 1
- PCSK9 and CETP inhibitors, mipomersen, and antisense oligonucleotides have shown promise in lowering Lp(a) levels 1
Clinical Significance
The clinical significance of elevated Lp(a) levels lies in their association with an increased risk of CVD and CAVD.
- Lp(a) is considered a causal mediator of CVD and CAVD 1
- Elevated Lp(a) levels are associated with higher event rates at any achieved LDL-C level 1
- Measuring Lp(a) levels is recommended in patients at high risk of CVD and targeting levels below 50 mg/dL 1
Risk-Enhancing Factor
Lp(a) is considered a risk-enhancing factor for CVD, especially at higher levels (>50 mg/dL or >125 nmol/L) 1
- Lp(a) measurement is recommended in patients with a family history of premature ASCVD or personal history of ASCVD not explained by major risk factors 1
From the Research
Clinical Significance of Elevated Lipoprotein(a) (Lp(a)) Levels
Elevated Lp(a) levels are associated with an increased risk of various cardiovascular diseases, including:
- Atherosclerotic cardiovascular disease (ASCVD) 2, 3, 4
- Calcific aortic valve disease (CAVD) 2, 3, 5
- Venous thromboembolism 2
Prevalence and Diagnosis
- Elevated Lp(a) levels (≥50 mg/dL) are a prevalent condition affecting over 20% of the population 2
- Lp(a) levels remain relatively constant throughout a person's life and are genetically determined 2, 4
- Routine Lp(a) testing has not been widely adopted, despite its potential to reclassify ASCVD risk and drive intensive cardiovascular risk factor management 4
Treatment and Management
- Current therapies for managing elevated Lp(a) levels include lipoprotein apheresis (LA), PCSK9 inhibitors, and antisense oligonucleotides (ASOs) 2, 6
- Statins have neutral or detrimental effects on Lp(a) levels 2, 6
- Novel therapeutics that specifically and potently lower Lp(a) levels are currently in advanced stages of clinical development 5