Elevated Lp(a) (increased cardiovascular risk): ≥50 mg/dL (≥125 nmol/L)5
Borderline cardiovascular risk: 30 mg/dL (75 nmol/L) to 50 mg/dL (125 nmol/L)2
Normal: <30 mg/dL (75 nmol/L)2,6
Lp(a) levels <3 mg/dL (7.5 nmol/L) to 5 mg/dL (12.5 nmol/L) are associated with an increased risk of incident type 2 diabetes mellitus2,7
All patients with clinical atherosclerotic cardiovascular disease (ASCVD), especially premature or recurrent ASCVD despite LDL lowering
All patients with a personal or family history of aortic valve stenosis
All individuals of South Asian or African ancestry, especially those with a family history of ASCVD or increased Lp(a)
All patients with a family history of premature ASCVD and/or elevated Lp(a)
All Individuals with a 10-year ASCVD risk ≥10% in the primary prevention setting, to stratify risk
Patients with refractory elevations of LDL-C despite aggressive LDL-C lowering therapy
Premature ASCVD for men <55 years of age and for women <54 years of age, particularly in the absence of traditional risk factors
A very high risk of ASCVD, to better define those who may benefit from lipid-lowering therapies
A family history of first-degree relatives with premature ASCVD for men <55 years of age and women <65 years of age
Primary severe hypercholesterolemia (LDL-C ≥190 mg/dL) or suspected familial hypercholesteremia (FH)
Intermediate (7.5%-19.9%) or borderline (5%-7.4%) 10-year ASCVD risk, to improve risk stratification in primary prevention when the decision to use a statin is uncertain
A family history of elevated Lp(a)
Less than anticipated LDL-C lowering, despite good adherence to LDL-C lowering therapy
Calcific aortic stenosis
Recurrent or progressive ASCVD, despite optimal lipid-lowering therapy
*The NLA grading system adopted the methodology and classification system used in the 2015 ACC/AHA clinical practice guideline recommendation classification system.
There are several ways you can help improve the outcomes of your patients with elevated Lp(a).
ICD-10=International Classification of Diseases, Tenth Revision; CPT=Current Procedural Terminology.
References: 1. Farzam K, Senthilkumaran S. Lipoprotein A. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Updated September 2, 2022. Accessed August 22, 2023. https://www.statpearls.com/ArticleLibrary/viewarticle/130795 2. 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;14:43(39):3925-3946. 3. Engler RJM, Brede E, Villines T, Vernalis MN. Lipoprotein(a) elevation: A new diagnostic code with relevance to service members and veterans. Fed Pract. 2019;36(Suppl 7):S19-S31. 4. Quest Diagnostics. Lipoprotein (a). Accessed August 22, 2023. https://testdirectory.questdiagnostics.com/test/test-detail/34604/lipoprotein-a?cc=MASTER 5. 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. 6. Tsimikas S. A test in context: Lipoprotein(a): Diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692-711. 7. Tsimikas S. In search of a physiological function of lipoprotein(a): causality of elevated Lp(a) levels and reduced incidence of type 2 diabetes. J Lipid Res. 2018;59(5):741-744. 8. Handelsman Y, Jellinger PS, Guerin CK, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the management of dyslipidemia and prevention of cardiovascular disease algorithm - 2020 Executive Summary. Endocr Pract. 2020;26(10):1196-1224. 9. 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.