This position statement provides guidance to cardiologists and related specialists
on the management of adult patients with elevated lipoprotein(a) [Lp(a)]. Elevated
Lp(a) is an independent and causal risk factor for atherosclerotic cardiovascular
disease (ASCVD) and calcific aortic valve disease (CAVD). While circulating Lp(a)
levels are largely determined by ancestry, they are also influenced by ethnicity,
hormones, renal function, and acute inflammatory events, such that measurement should
be done after accounting for these factors. Further, circulating Lp(a) concentrations
should be estimated using an apo(a)-isoform independent assay that employs appropriate
calibrators and reports the results in molar units (nmol/L). Selective screening strategies
of high-risk patients are recommended, but universal screening of the population is
currently not advised. Testing for elevated Lp(a) is recommended in all patients with
premature ASCVD and those considered to be at intermediate-to-high risk of ASCVD.
Elevated Lp(a) should be employed to assess and stratify risk and to enable a decision
on initiation or intensification of preventative treatments, such as cholesterol lowering
therapy. In adult patients with elevated Lp(a) at intermediate-to-high risk of ASCVD,
absolute risk should be reduced by addressing all modifiable behavioural, lifestyle,
psychosocial and clinical risk factors, including maximising cholesterol-lowering
with statin and ezetimibe and, where appropriate, PCSK9 inhibitors. Apheresis should
be considered in patients with progressive ASCVD. New ribonucleic acid (RNA)-based
therapies which directly lower Lp(a) are undergoing clinical trials.
Keywords
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Article info
Publication history
Published online: January 25, 2023
Accepted:
November 9,
2022
Received:
October 19,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.