Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society

doi:10.1016/j.atherosclerosis.2023.04.012

Review

. 2023 Jun:374:107-120.

doi: 10.1016/j.atherosclerosis.2023.04.012. Epub 2023 Apr 28.

Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society

Florian Kronenberg¹, Samia Mora², Erik S G Stroes³, Brian A Ference⁴, Benoit J Arsenault⁵, Lars Berglund⁶, Marc R Dweck⁷, Marlys L Koschinsky⁸, Gilles Lambert⁹, François Mach¹⁰, Catherine J McNeal¹¹, Patrick M Moriarty¹², Pradeep Natarajan¹³, Børge G Nordestgaard¹⁴, Klaus G Parhofer¹⁵, Salim S Virani¹⁶, Arnold von Eckardstein¹⁷, Gerald F Watts¹⁸, Jane K Stock¹⁹, Kausik K Ray²⁰, Lale S Tokgözoğlu²¹, Alberico L Catapano²²

Affiliations

¹ Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: Florian.Kronenberg@i-med.ac.at.
² Center for Lipid Metabolomics, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
³ Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK.
⁵ Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, and Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada.
⁶ Department of Internal Medicine, School of Medicine, University of California-Davis, Davis, CA, USA.
⁷ British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
⁸ Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
⁹ Inserm, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, 97400, Saint-Pierre, La Réunion, France.
¹⁰ Department of Cardiology, Geneva University Hospital, Geneva, Switzerland.
¹¹ Division of Cardiology, Department of Internal Medicine Baylor Scott & White Health, 2301 S. 31st St., Temple, TX, 76508, USA.
¹² Atherosclerosis and Lipoprotein-apheresis Clinic, University of Kansas Medical Center, Kansas City, KS, USA.
¹³ Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; and Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
¹⁴ Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁵ Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians University Klinikum, Munich, Germany.
¹⁶ The Aga Khan University, Karachi, Pakistan; Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA.
¹⁷ Institute of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁸ Medical School, University of Western Australia, and Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia.
¹⁹ European Atherosclerosis Society, Mässans Gata 10, SE-412 51, Gothenburg, Sweden.
²⁰ Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
²¹ Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
²² Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, and IRCCS MultiMedica, Milan, Italy.

PMID: 37188555
DOI: 10.1016/j.atherosclerosis.2023.04.012

Free article

Review

Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society

Florian Kronenberg et al. Atherosclerosis. 2023 Jun.

Free article

. 2023 Jun:374:107-120.

doi: 10.1016/j.atherosclerosis.2023.04.012. Epub 2023 Apr 28.

Authors

Affiliations

¹ Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: Florian.Kronenberg@i-med.ac.at.
² Center for Lipid Metabolomics, Division of Preventive Medicine, and Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
³ Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Centre for Naturally Randomized Trials, University of Cambridge, Cambridge, UK.
⁵ Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, and Department of Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada.
⁶ Department of Internal Medicine, School of Medicine, University of California-Davis, Davis, CA, USA.
⁷ British Heart Foundation Centre for Cardiovascular Science, Edinburgh Heart Centre, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
⁸ Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
⁹ Inserm, UMR 1188 Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, 97400, Saint-Pierre, La Réunion, France.
¹⁰ Department of Cardiology, Geneva University Hospital, Geneva, Switzerland.
¹¹ Division of Cardiology, Department of Internal Medicine Baylor Scott & White Health, 2301 S. 31st St., Temple, TX, 76508, USA.
¹² Atherosclerosis and Lipoprotein-apheresis Clinic, University of Kansas Medical Center, Kansas City, KS, USA.
¹³ Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; and Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA.
¹⁴ Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁵ Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians University Klinikum, Munich, Germany.
¹⁶ The Aga Khan University, Karachi, Pakistan; Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA.
¹⁷ Institute of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁸ Medical School, University of Western Australia, and Department of Cardiology, Lipid Disorders Clinic, Royal Perth Hospital, Perth, Australia.
¹⁹ European Atherosclerosis Society, Mässans Gata 10, SE-412 51, Gothenburg, Sweden.
²⁰ Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
²¹ Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
²² Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, and IRCCS MultiMedica, Milan, Italy.

PMID: 37188555
DOI: 10.1016/j.atherosclerosis.2023.04.012

Abstract

In 2022, the European Atherosclerosis Society (EAS) published a new consensus statement on lipoprotein(a) [Lp(a)], summarizing current knowledge about its causal association with atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. One of the novelties of this statement is a new risk calculator showing how Lp(a) influences lifetime risk for ASCVD and that global risk may be underestimated substantially in individuals with high or very high Lp(a) concentration. The statement also provides practical advice on how knowledge about Lp(a) concentration can be used to modulate risk factor management, given that specific and highly effective mRNA-targeted Lp(a)-lowering therapies are still in clinical development. This advice counters the attitude: "Why should I measure Lp(a) if I can't lower it?". Subsequent to publication, questions have arisen relating to how the recommendations of this statement impact everyday clinical practice and ASCVD management. This review addresses 30 of the most frequently asked questions about Lp(a) epidemiology, its contribution to cardiovascular risk, Lp(a) measurement, risk factor management and existing therapeutic options.

Keywords: Atherosclerotic cardiovascular disease; Genetic risk; Risk calculator; Risk factor management; lipoprotein(a).

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Conflict of interest statement

Declaration of competing interest Potential conflicts of interest outside the submitted work are summarized below. The following authors report participation in trials; receipt of fellowships, or grants for travel, research or staffing support; and/or personal honoraria for consultancy or lectures/speaker’s bureau from: Abbott (KKR, LST, BG Nordestgaard [BGN]), Abcentra (M Koschinsky [MK]), Abdi-Ibrahim (LST), Actelion (LST), Aegerion (ALC, PM Moriarty [PMM]), Affiris AG (G Lambert [GL]), Akcea (ALC, BGN, KG Parhofer [KGP], ESGS), Amarin (ALC, PMM, BGN, KGP), Amgen (ALC, BA Ference [BAF], F Kronenberg [FK], F Mach [FM], PMM, P Natarajan [PN], BGN, KGP, KKR, ESGS, LST, GF Watts [GFW]), Amgen Germany (A von Eckardstein [AvE]), Amgen Switzerland (AvE), Amryt (ALC), Amundsen/Amgen (FM), Apple (PN), Arrowhead (GFW), Ayma Therapeutics (MK), AstraZeneca (ALC, PN, BGN, KKR, GFW), Bayer (LST), Berlin-Chemie (KGP), Boehringer-Ingelheim (KKR), Boston Scientific (PN), CiVi Pharma (BAF), Daiichi-Sankyo (ALC, BAF, FM, KGP, KKR, LST), Daiichi Switzerland (AvE), dalCOR (BAF), Denka (BGN), Eli Lilly (ALC, BAF, MK, KKR), Esperion (ALC, BAF, PMM, BGN, KKR, ESGS, GFW), FH Foundation (PMM), Foresite Labs (PN), Fresenius (FK), GB Life Sciences (PMM), Genentech (PN), Genzyme (ALC), Horizon/Novartis (FM, BGN), Ionis Pharmaceuticals (BA, ALC, BAF, BGN, MK, PMM), Jupiter Bioventures (MR Dweck [MRD]), Kaneka (FK, PMM), Kowa (ALC, BGN, KKR), KrKa Phama (BAF), Lupin (KKR), Menarini (ALC), Merck (ALC, BAF), MSD (KGP), Mylan (ALC, BAF, LST), New Amsterdam (KKR), Noetic Insights (MK), Novartis (B Arsenault [BA], ALC, MRD, BAF, FK, FM, CJ McNeal [CJMN], PMM, PN, BGN, KGP, KKR, ESGS, LST, GFW), Novartis Canada (MK), NovoNordisk (BAF, CJMN, BGN, KKR, ES, LST), Nyrada Inc (GL), Pfizer (BA, MRD, BAF, MK,SM, KKR, LST, GFW), Quest Diagnostics (SM), Recordati (ALC, LST), Regeneron (ALC, BAF, PMM, BGN, KKR, ESGS), Renew (PMM), Resverlogix (KKR), Sandoz (ALC), Sanofi (ALC, BAF, FM, BGN, KGP, KKR, ESGS, LST, GFW), Sanofi-Aventis Switzerland (AvE), Sanofi-Regeneron (GL, ESGS), Servier (LST), Sigma Tau (ALC), Silence Therapeutics (BA, MRD, BAF, BGN, KKR, GFW), The Medicines Co (BAF) and UltraGenyx (BGN). PN declares spousal employment at Vertex and KGP is a member of the Data Monitoring and Safety Board at Boehringer-Ingelheim. SSV declares an honorarium from the American College of Cardiology (Associate Editor for Innovations, acc.org), and grant funding from the U.S. Department of Veterans Affairs, National Institutes of Health, World Heart Federation, and Tahir and Jooma Family. Manuscripts have been published in collaboration with non-academic co-authors by PN and LST (Fitbit), GFW (Amgen), and BA (Pfizer). Equity interests including income from stocks, stock options, royalties, or from patents or copyrights were reported from AstraZeneca (JKS), Boston Scientific (L Berglund [LB]), Cargene Therapeutics (KKR), Gilead Sciences (LB), J & J (LB), GSK (JKS), Medtronic (LB), New Amsterdam Pharma (KKR), NovoNordisk (LB), Pemi31 Therapeutics (KKR), and Pfizer (LB).KKR is President of the European Atherosclerosis Society. LST is Past-President of the European Atherosclerosis Society and an Editorial Board Member, The European Heart Journal.

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Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society

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Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society

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Conflict of interest statement

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