Use of Lipoprotein(a) in Clinical Practice

Publication Date: April 1, 2024

Last Updated: April 1, 2024

Recommendations

Epidemiological Data

The relationship between baseline Lp(a) level and ASCVD events is continuous and log-linear, with increased risk even at “lower-risk” levels.
Despite differences in Lp(a) levels among racial/ethnic groups, Lp(a)-attributable risk is similar, eliminating previous race-based definitions of elevated Lp(a).
Because accepted conversion factors to adjust for Lp(a)-C in LDL-C calculation have proven inaccurate, leading to under treatment of high-risk patients, such adjustments should not be used.

Treatment

Lipoprotein apheresis is the first therapy to receive a U.S. Food and Drug Administration indication for Lp(a) reduction, for use in high-risk patsients with FH, ASCVD, elevated Lp(a), and elevated LDL-C.
Emerging pharmacological agents that specifically target Lp(a) are in development and undergoing testing in clinical trials as potential future therapies.

Recommendations

Adults (aged ≥18 y): Measurement of Lp(a) in all adults is reasonable to refine risk assessment for ASCVD events (COR I, LOE B-NR).
When Lp(a) levels are used for ASCVD risk assessment, it is reasonable to use measurements ≥125 nmol/L (≥50 mg/dL) as levels suggesting high risk, levels <75 nmol/L (<30 mg/dL) as low risk, and levels between as intermediate risk (COR IIa, LOE B-NR).
The use of an adjustment factor to estimate Lp(a)-C for correction of calculated LDL-C is not recommended (COR III [no benefit], LOE C-EO).
Lipoprotein apheresis is an FDA-approved therapy for high-risk patients with FH and ASCVD (coronary or peripheral arteries) whose Lp(a) level remains ≥60 mg/dL (∼150 nmol/L) and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy (COR IIa, LOE B-NR).

Use of Lipoprotein(a) in Clinical Practice