Lp(a): Global Public Health Concern: Emerging Knowledge and Therapeutic Approaches.

Purpose of review: Lipoprotein(a) [Lp(a)] is an apolipoprotein B-containing lipoprotein that is a genetic causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease. This review focuses on new findings and treatment approaches for individuals with elevated Lp(a) across the spectrum of ASCVD.

Recent findings: One in five individuals globally have elevated Lp(a) (> 125 nmol/L or > 50 mg/dL). Emerging knowledge related to Lp(a) includes demonstration of poor rates of Lp(a) testing, comparison of methods for Lp(a) measurement, natural variability in Lp(a) levels, the continuous association between Lp(a) and ASCVD risk, atherogenicity in comparison with LDL, risk in context of other risk factors, coronary plaque characteristics, and the association of Lp(a) with a broader range of outcomes. Optimal risk factor control, including LDL-cholesterol lowering, is a cornerstone of management. When indicated, shared decision-making to discuss antiplatelet therapy for individuals with very-high Lp(a) may also be helpful. Several Lp(a)-lowering therapies are under investigation in ASCVD outcome trials. While Lp(a) is a well-established risk factor for ASCVD, there are several areas of growing knowledge related to Lp(a), and management strategies of individuals with elevated Lp(a) continue to evolve with targeted therapies currently in late-stage clinical trials.