Managing Elevated Lp(a)

An Lp(a) test can help inform next steps for your premature CVD patients and their family members.

Elevated Lp(a)^† and Looking Forward

Elevated Lp(a) may be an important piece to the puzzle for people with a personal or family history of premature ASCVD. Watch the video to see how an Lp(a) test can empower your patients to take charge of their CV health.^1,2

^†Elevated Lp(a) levels defined as ≥50 mg/dL or ≥125 nmol/L.¹

Lp(a) Testing Matters: A Real-World Perspective From Stephanie J Saucier, MD, FACC, RPVI

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To hear Lp(a) doesn't matter is kind of heartbreaking, I think. It's invisible until your first heart attack, and it's invisible till your first stroke. So, I think that if we're recognizing it in testing patients, then I think it's going to give them power to really have a better understanding of themselves. Hello, my name is Dr. Stephanie Saucier, and today I'm going to be talking about why Lp(a) is so vitally important to your patients, to your practice, and may be the missing puzzle piece to patient care. I think that when we're talking about patients who already have premature cardiovascular disease, the fact that one in three of those patients may have high Lp(a) is very profound. This patient that I have, he was vegan and exercised every day. And yet his family members, the men in his family specifically, most of them had heart attacks in their 40s. And he was like, you know, I'm doing all of the right things until one day in his mid-40s, he had his heart attack. And he, in addition to having his heart attack, was diagnosed with having a significantly elevated Lp(a), and it changed his life forever. It changed his life forever because he wasn't managing his mildly elevated LDL cholesterol, but after his heart attack and with the knowledge that he has high Lp(a), his life changed. His family members were tested. He is just taking this knowledge to really empower himself and help him prevent a future event. And so all of his changes that he's made in his life because of the knowledge of his high Lp(a) and also his premature atherosclerotic cardiovascular disease and his family history, it changed the story for him. A lot of patients are really motivated to make sure that they live long for the people that they love, whether it be their kids or, you know, their loved ones. We know that across the country, it is not being tested as often as it should be. The National Lipid Association put out recommendations in 2024 that every person over the age of 18 be tested for Lp(a) at least once in their lifetime. I've come into contact with peers who have had the perception of, “We don't have a treatment currently to treat Lp(a), so why am I going to test for it?” And what I always tell them is: because you can modify their risk, right? You can be more aggressive. You have the opportunity with the knowledge that this is another risk factor that these patients have. You have an opportunity to change their risk, and to modify it, and to give them better care. Maybe if we're testing more patients, then maybe we could potentially move the needle on heart disease. I really think that Lp(a) testing is one of the missing puzzle pieces in terms of cardiovascular risk assessment. That is, when we finally start testing patients more than we already are, it's going to make the picture finally come into view.

Next Steps for Your Patients

Currently there are no FDA-approved pharmacotherapies to decrease Lp(a) levels. But there are still many steps you can take right now to help your patients with elevated Lp(a).¹

An elevated Lp(a) diagnosis can help drive conversations with your patients about management of their other modifiable CV risk factors, treatment initiation, adherence, and lifestyle behaviors^1-4

Understanding the role that elevated Lp(a) can play in familial CV risk may help reinforce proactive and heart-healthy behaviors in both patients and their family members^1-6

Patients who have had a CV event are at increased risk for a recurrence^7-10

Optimized management of other modifiable CV risk factors in patients with elevated Lp(a) (defined as ≥50 mg/dL or ≥125 nmol/L) is important to sufficiently reduce overall CV risk^1,4,11,12

If your patients have elevated Lp(a), testing their family members can uncover those who may also be at risk^1,13

Lp(a) levels are ~90% genetically determined^5,6
Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk for ASCVD^1,13

Lp(a) testing may help provide a deeper understanding of your patients currently considered at a lower risk^11,14

Elevated levels of Lp(a) can increase baseline risk for a CV event¹¹
Lp(a) testing has been shown to improve the accuracy of CV risk stratification¹⁴

Programs and communities are available to support people living with elevated Lp(a).

Explore Patient Resources

ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular; CVD, cardiovascular disease; Lp(a), Lipoprotein (a).

References: 1. Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. 2024;18(3):e308-e319. 2. 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. 3. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation. 2019;139(25):e1082-e1143. 4. 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;7:32-40. 5. Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692-711. 6. Reyes-Soffer G, Ginsburg H, Berglund L, et al. 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. 7. MacDougall DE, Tybjærg-Hansen A, Knowles JW, et al. Lipoprotein(a) and recurrent atherosclerotic cardiovascular events: the US Family Heart Database. Eur Heart J. 2025 May 7:ehaf297. Published online May 7, 2025. 8. Welsh P, Zabiby AA, Byrne H, et al. Elevated lipoprotein(a) increases risk of subsequent major adverse cardiovascular events (MACE) and coronary revascularisation in incident ASCVD patients: a cohort study from the UK Biobank. Atherosclerosis. 2024;389:1-8. 9. Madsen CM, Kamstrup PR, Langsted A, et al. Lipoprotein(a)-lowering by 50 mg/dL (105 nmol/L) may be needed to reduce cardiovascular disease 20% in secondary prevention. Arterioscler Thromb Vasc Biol. 2020;40:255-266. 10. Berman AN, Biery DW, Besser SA, et al. Lipoprotein(a) and major adverse cardiovascular events in patients with or without baseline atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2024;83(9):873-886. 11. 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. 12. Thanassoulis G. Screening for high lipoprotein(a). Circulation. 2019;139(12):1493-1496. 13. Chakraborty A, Chan D, Ellis K, et al. Cascade testing for elevated lipoprotein(a) in relatives of probands with familial hypercholesterolaemia and elevated lipoprotein(a). Am J Prev Cardiol. 2022;349:219-226. 14. Willeit P, Kiechl S, Kronenberg F, et al. Discrimination and net reclassiﬁcation of cardiovascular risk with lipoprotein(a). J Am Coll Cardiol. 2014;64(9):851-860.

Elevated Lp(a)† and Looking Forward

Lp(a) Testing Matters: A Real-World Perspective From Stephanie J Saucier, MD, FACC, RPVI

Read the Transcript

Next Steps for Your Patients

An elevated Lp(a) diagnosis can help drive conversations with your patients about management of their other modifiable CV risk factors, treatment initiation, adherence, and lifestyle behaviors1-4

Patients who have had a CV event are at increased risk for a recurrence7-10