Lipoprotein (a) [Lp(a)]

Abstract

Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD)-related events including myocardial infarction, ischemic stroke, and valvular aortic stenosis. Levels of Lp(a) reach adult levels by 5 years of age and remain constant throughout the lifespan. Lifestyle modifications including exercise and dietary changes and statins do not lower Lp(a) levels. Proprotein convertase subtilisin/kexin type 9 inhibitors can decrease Lp(a) levels. There is lack of data on reduction in ASCVD risk secondary to a decrease in the Lp(a) level independent of the effect on LDL cholesterol lowering. Lp(a) normative ranges vary with ethnicity. Guidelines on screening for elevated Lp(a) in adults vary with some experts suggesting universal screening at least once during lifetime and others suggesting targeted screening in selected patients. Among youth (age <20 years), current guidelines state that measurement of Lp(a) may be reasonable in patients with clinically suspected or genetically confirmed familial hypercholesterolemia, family history of first-degree relatives with premature ASCVD, an unknown cause of ischemic stroke or a parent or sibling with an elevated Lp(a). There is need for larger studies to determine cut-off Lp(a) levels for various ethnic groups that predict higher ASCVD risk and study the impact of reduction of Lp(a) levels on ASCVD outcomes.