Familial hypercholesterolemia (FH), or other genetic dyslipidaemias
A personal or family history of premature atherosclerotic cardiovascular disease (ASCVD), less than 60 years of age
First degree relatives with raised serum Lp(a) levels (> 200 nmol/l)
Calcific aortic valve stenosis (CAVS)
A borderline increased (but <15%) 10-year risk of a cardiovascular (CV) event
It is well-established that Lp(a) concentrations and their distribution vary with ethnicity and local population structures.1 Black populations have the highest Lp(a) level of all ethnicities followed by South Asians, Whites, Hispanics, and East Asians.2
Ethnic differences in Lp(a) can be partly explained by differences in LPA gene locus size and single nucleotide polymorphisms. Elevated Lp(a) level is associated with CV disease risk in all ethnic groups.2
The measurement of Lp(a) levels is recommended by numerous national and international guidelines in patients with premature, recent, recurrent, and a family history of CV events; some recommend Lp(a) testing at least once in all adults.
2023 National Clinical Guidelines for Stroke (for the UK and Ireland) also recommended Lp(a) testing in patients with ischaemic stroke or transient ischaemic attack of presumed atherosclerotic cause below 60 years of age and refer to a specialist if Lp(a) raised above 200 nmol/L.15
AAS, Australian Atherosclerosis Society; ACC, American College of Cardiology; AACE/ACE, American College of Clinical Endocrinology/American College of Endocrinology; AHA, American Heart Association; BHS, Beijing Heart Society; CCS, Canadian Cardiovascular Society; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; FAS, French Atherosclerosis Society; LAI, Lipid Association of India; NLA, National Lipid Association.
Management of patients with raised Lp(a)
Knowing the extent of Lp(a)-mediated risk can inform treatment intensification of global cardiovascular disease (CVD) risk factor management. Lp(a) testing can reveal a common underlying genetic cause of CVD risk, often explaining premature events or family history. Patients knowing and understanding their Lp(a) status could inform positive behavioural change (e.g. motivation to adhere to treatments and lifestyle changes).
HEART UK’s consensus statement provides recommendations for managing patients, in both primary and secondary prevention, with raised Lp(a) levels (> 90 nmol/l).1 These include:
- reducing overall atherosclerotic risk
- controlling dyslipidaemia and
- consideration of lipoprotein apheresis as per the HEART UK Lipoprotein apheresis statement.
The CV conferred by Lp(a) is graded dependent on the Lp(a) level.
