Lp(a): A Toolkit for Health Care Professionals

7 Elevated Lp(a): What Are the Risks? * Treatment strategy: Consider implementation of aggressive LDL-C lowering strategies in patients with elevated Lp(a). ** Treatment strategy: Maximally manage treatable risk factors in patients with elevated Lp(a). Of Note … Patients with elevated Lp(a) are at risk even if their LDL-C is optimally controlled by statins. 16 In particular, residual risk for a recurrent event is about 10% even when statins and other lipid-lowering therapies (i.e., PCSK9 inhibitors) are used to lower LDL-C. 17 Lipoprotein apheresis is currently the only FDA approved treatment (April 2020) for elevated Lp(a) in those with Functional Hypercholesterolemic Heterozygotes with LDL-C ≥ 100 mg/dl and lipoprotein(a) [Lp(a)] ≥ 60 mg/dL, and either documented coronary artery disease and/or documented peripheral artery disease. 18 People with borderline or slightly elevated LDL-C are three to four times more likely to have ASCVD events than those with low LDL-C. 12 * Lp(a) can pose greater risk for acute coronary syndrome when LDL-C is elevated. 13 People who have clinical ASCVD (including acute coronary syndrome; those with stable angina or a history of myocardial infarction or coronary or other arterial revascularization; stroke; transient ischemic attack; or peripheral artery disease, including aortic aneurysm, all of atherosclerotic origin 14 ), are at higher risk for future events if Lp(a) is elevated. In the general population, Lp(a) levels greater than 50 mg/ dL (~ 125 nmol/L) are associated with an approximately 20% increased risk of CHD events. Each 3.5-fold increase in Lp(a) is associated with a 16% increase of risk. 15 * Elevated Lp(a) values represent an independent risk factor for ischemic stroke (more relevant in young stroke patients), PAD and aortic and mitral valve stenosis. In people with established CHD, elevated Lp(a) levels increase the risk of coronary heart disease and general cardiovascular events, particularly in those with LDL-C ≥ 130 mg/dL. 4,25 Elevated Lp(a) seems to be associated with atherosclerotic renal artery stenosis in patients with low LDL-C. 4