Lipoprotein(a): Actionable today, treatable tomorrow?

BACKGROUND

Lipoprotein(a) (Lp(a)) is an atherogenic, low-density lipoprotein (LDL)-like particle whose concentrations, mostly genetically determined, are elevated in about 20% of individuals. It is a major and under-recognised independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis.

OBJECTIVE

To review current evidence, international recommendations and future directions around testing and management of elevated Lp(a).

DISCUSSION

Among other high-risk groups, measuring Lp(a) is recommended in people with ASCVD or aortic valve stenosis, especially if they are of young-onset, familial, unusually severe or progressive. Indeed, some international guidelines advocate measuring Lp(a) in all adults as part of cardiovascular risk assessment. While specific Lp(a)-lowering therapies are not yet available, risk-reducing measures for people with raised Lp(a) include addressing absolute ASCVD risk by diet and lifestyle measures, along with pharmacological LDL-cholesterol reduction. Aspirin might also have a role in primary prevention. Lp(a)-lowering therapies that act by preventing its formation are the subjects of ongoing clinical trials focused on cardiovascular outcomes, the first of which is expected to report in late 2026.