Lipoprotein(a): a genetic cardiovascular risk factor
Approximately 1 in 5 people worldwide have elevated Lp(a) levels defined as ≥125 nmol/L or 50 mg/dL.1 That’s an estimated 1.43 billion people worldwide.1
Typical distribution of Lp(a) in the general population5
Elevated Lp(a) is highly prevalent
Unlike LDL-C Levels which have a normal distribution, Lp(a) levels are skewed in most populations.5 Elevated Lp(a) influences atherogenicity from birth1, Lp(a) is approximately 6-fold more atherogenic than LDL on a per particle basis10
Figure adapted from Nordestgaard BG, et al. Eur Heart J. 2010;31(23):2844–2853.
Elevated lipoprotein(a), also known as lipoprotein 'little a', or Lp(a), is a genetically determined and independent risk factor that increases cardiovascular disease risk.1,4 Lp(a) serves as a valuable indicator of susceptibility to CVD-related events and conditions.1,5
For example, individuals with elevated Lp(a) (>117 mg/dL) are 2.6 times more likely to experience a myocardial infarction (MI) compared to individuals with Lp(a) <5 mg/dL.6 An Lp(a) level of ~250 nmol/L (100 mg/dL) approximately doubles the risk of an atherosclerotic cardiovascular disease (ASCVD) event, irrespective of an individual’s absolute risk at baseline according to research in 2022 and 2023.5
And yet, despite approximately 1 in 5 people worldwide having elevated Lp(a) levels,1 it is not routinely tested in day-to-day clinical practice.
The potential value of including Lp(a) testing in cardiovascular risk evaluation
There is an addressable gap in Lp(a) testing in the UK. The inclusion of Lp(a) testing could be beneficial from a clinical and patient perspective, as knowledge of Lp(a) levels can help to offer a clearer understanding of your patients’ overall CVD risk. It could:
- enhance CVD risk prediction
- enable reclassification of individuals or patients into higher risk categories who may otherwise not meet guideline criteria for lipid-lowering therapy11-14
More accurate risk assessment of ASCVD patients, particularly in those who have already experienced a CV event, can help to reduce a patient’s risk of a subsequent event and, in turn, reduce the significant burden of CVD across the NHS.15-17
Lp(a) testing may improve CVD risk assessment in primary and secondary prevention settings
- One in three patients with very elevated Lp(a) levels* were reclassified into a higher primary prevention risk category
- >50% of all patients with very elevated Lp(a) levels* were reclassified into a higher secondary prevention risk category
SCORE: Conroy et al. Eur Heart J 2003;24:987–1003; https://www.heartscore.org/en_GB (Last accessed July 2024)
SMART: Dorresteijn et al. Heart 2013;99:866–872; https://u-prevent.com/calculators/smartScore (Last accessed July 2024);
*>99th percentile, mean Lp(a) of 460 nmol/L.
Identification of elevated Lp(a)
There exists a great opportunity to implement Lp(a) testing during routine cholesterol checks. Testing once in a lifetime, particularly in those within the post-CV event population, could help healthcare professionals (HCP) to better understand their patients’ overall CVD risk, inform treatment intensification and management of global CVD risk factors, as well as identify a potential underlying genetic cause of CVD risk which could help provide a deeper understanding of premature events or family history.
Testing Lp(a) in your patients with CVD could help to accurately assess their risk of having another event, allowing appropriate and timely interventions to take place to improve patient outcomes.15-17
