Learn how elevated Lp(a) impacts cardiovascular risk

Even in the absence of other cardiovascular risk factors, elevated Lp(a) may be a threat.^3,4 Watch this video to see what may be hiding in your patients' routine blood work.

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At normal levels, Lp(a) may help promote tissue repair and accelerate wound healing.^6,7

At elevated levels of ≥50 mg/dL (≥125 nmol/L), Lp(a) can increase lifelong risk of cardiovascular disease, aortic valve stenosis, coronary artery disease, heart attack, and stroke via proatherogenic, proinflammatory, and prothrombotic mechanisms.^5,8,9

See the Data

Lp(a) is a unique and large prothrombotic glycoprotein called apo(a), bound to ApoB. Lp(a) levels are determined by genetic variants: the number of copies in the kringle IV type 2 (KIV-2) domain of apo(a) is variable and correlates inversely with Lp(a) concentrations.⁹

See the data for coronary artery disease (CAD) and ischemic heart disease (IHD)

CADIHD

Elevated Lp(a) levels are established by 5 years of age and remain relatively consistent over time.^5,13 Endothelial dysfunction associated with high Lp(a) levels has been detected in children as young as 11 years of age.¹⁴

See the Risk

See the data for aortic valve calcification (AVC) and prevalence of calcific aortic valve stenosis (CAVS)^15,16

See the Data for CAVS-P

See the Data for AIS

Certain groups of individuals are at additional risk from elevated Lp(a)

For women after menopause:

• Elevated Lp(a) is associated with the presence and severity of new-onset coronary artery disease (CAD) and obstructive CAD^19,20

For people with diabetes or prediabetes:

• Elevated Lp(a) was associated with a significant increase in ASCVD risk in Caucasian individuals with diabetes (HR=1.59; 95% CI 1.18–2.15) or prediabetes (HR=1.40; 95%CI 1.09–1.81)²¹

For people of African ancestry:

• Lp(a) levels of >30 mg/dL are associated with an up to 2-fold increased risk of incident ischemic stroke. Median Lp(a) levels are also highest compared with other racial subgroups^22,23

For people of South Asian ancestry:

• Median Lp(a) levels are second highest after those of African ancestry and may account, in part, for their tendency to develop premature CAD^2,24,25

References: 1. Tsimikas S, Fazio S, Ferdinand KC, et al. NHLBI Working Group recommendations to reduce Lipoprotein(a)-mediated risk of cardiovascular disease and aortic stenosis. J Am Coll Cardiol. 2018;71(2):177-192. 2. Tsimikas S. A test in context: Lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692-711. 3. Enas EA, Varkey B, Dharmarajan TS, Pare G, Bahl VK. Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction. Indian Heart J. 2019;71(2):99-112. 4. Willeit P, Kiechl S, Kronenberg F, et al. Discrimination and net reclassification of cardiovascular risk with Lipoprotein(a): prospective 15-year outcomes in the Bruneck Study. J Am Coll Cardiol. 2014;64(9):851-860. 5. Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-3946. 6. Orsó E, Schmitz G. Lipoprotein(a) and its role in inflammation, atherosclerosis and malignancies. Clin Res Cardiol. 2017;12(Suppl 1):31-37. 7. Safiullah ZN, Leucker T, Jones SR, et al. Physiological Roles and Functions of Lipoprotein(a). In: Lipoprotein(a). Contemporary Cardiology. Humana, Cham; 2023. 8. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;10;140(11):e596-e646. 9. Reyes-Soffer G, Ginsberg HN, Berglund L, et al; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease. Lipoprotein(a): A genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42(1):e48-e60. 10. Clarke R, Peden JF, Hopewell JC, et al; PROCARDIS Consortium. Genetic variants associated with Lp(a) Lipoprotein level and coronary disease. N Engl J Med. 2009;361(26):2518-2528. 11. Kamstrup PR, Tybjaerg-Hansen A, Steffensen R, Nordestgaard BG. Genetically elevated Lipoprotein(a) and increased risk of myocardial infarction. JAMA. 2009;301(22):2331-2339. 12. Virani SS, Koschinsky ML, Maher L, et al. Global think tank on the clinical considerations and management of Lipoprotein(a): The top questions and answers regarding what clinicians need to know. Prog Cardiovasc Dis. 2022;73:32-40. https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/02/08/05/Lipoproteina-in-Clinical-Practice 13. Scheel P, Meyer J, Blumenthal RS, Martin SS. Lipoprotein(a) in clinical practice. A commentary based on Wilson DP, Jacobson TA, Jones PH, et al. Use of lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019;13(3)374-392. J Am Coll Cardiol. July 2, 2019. Accessed August 22, 2023. https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/02/08/05/Lipoproteina-in-Clinical-Practice 14. Lapinleimu J, Raitakari OT, Lapinleimu H, et al. High Lipoprotein(a) concentrations are associated with impaired endothelial function in children. J Pediatr. 2015;166(4):947-952.e1-2. 15. Kaiser Y, Singh SS, Zheng KH, et al. Lipoprotein(a) is robustly associated with aortic valve calcium. Heart. 2021;107(17):1422-1428. 16. Kamstrup PR, Tybjærg-Hansen A, Nordestgaard BG. Elevated Lipoprotein(a) and risk of aortic valve stenosis in the general population. J Am Coll Cardiol. 2014;63(5):470-477. 17. Capoulade R, Chan KL, Yeang C, et al. Oxidized phospholipids, Lipoprotein(a), and progression of calcific aortic valve stenosis. J Am Coll Cardiol. 2015;66(11):1236-1246. 18. Arnold M, Schweizer J, Nakas CT, et al. Lipoprotein(a) is associated with large artery atherosclerosis stroke aetiology and stroke recurrence among patients below the age of 60 years: results from the BIOSIGNAL study. Eur Heart J. 2021;42(22):2186-2196. 19. Sposito AC, Mansur AP, Maranhão RC, Martinez TR, Aldrighi JM, Ramires JA. Triglyceride and lipoprotein (a) are markers of coronary artery disease severity among postmenopausal women. Maturitas. 2001;39(3):203-208. 20. Yan XN, Jin JL, Hong LF, et al. Lipoprotein(a) is associated with the presence and severity of new-onset coronary artery disease in postmenopausal women. J Womens Health (Larchmt). 2020;29(4):503-510. 21. Saeed A, Sun W, Agarwala A, et al. Lipoprotein(a) levels and risk of cardiovascular disease events in individuals with diabetes mellitus or prediabetes: The Atherosclerosis Risk in Communities study. Atherosclerosis. 2019;282:52-56. 22. Virani SS, Brautbar A, Davis BC, et al. Associations between Lipoprotein(a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2012;125(2):241-249. 23. Reyes-Soffer G. The impact of race and ethnicity on Lipoprotein(a) levels and cardiovascular risk. Curr Opin Lipidol. 2021;32(3):163-166. 24. Enas EA, Varkey B, Dharmarajan TS, et al. Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians. Indian Heart J. 2019;71(3):184-198. 25. Mehta A, Jain V, Saeed A, et al. Lipoprotein(a) and ethnicities. Atherosclerosis. 2022;349:42-52. 26. McGowan M, Wilemon K, Ahmed C, et al. Characterization of Lipoprotein(a) measurement in a large US healthcare dataset. J Clin Lipidol. 2022;16(Suppl 3):e36-e37.