A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice
- PMID: 38565461
- DOI: 10.1016/j.jacl.2024.03.001
A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice
Abstract
Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30-50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention.
Keywords: Cardiovascular disease; Guidelines; Lipoprotein(a); Prevention; Risk assessment; Scientific statements; Treatment practice.
Copyright © 2024 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Declaration of interest statement Marlys L. Koschinsky received honoraria from Novartis and Eli Lilly as a consultant and a research contract from Abcentra as an independent research contractor; Archna Bajaj received research support from Amgen, Ionis, Novartis, NewAmsterdam Pharma, and Regeneron and consulting fees from Kaneka; Michael B. Boffa has no interests to declare; Dave L. Dixon received research funding from Boehringer Ingelheim as a PI; Keith C. Ferdinand received consulting fees from Amgen, Sanofi, Novartis, Eli Lilly, Boehringer Ingelheim, Medtronic, and Janssen as a consultant; Samuel S. Gidding received a consulting fee from Esperion as Steering Committee Chair for pediatric studies of bempedoic acid; Edward A. Gill has been a consultant for Let's Get Checked and has received research funding paid to his institution from Kaneka as a PI; Terry A Jacobson received consultant fees from Amgen, AstraZeneca, Esperion, Novartis, and Regeneron for consulting; Erin D. Michos received honoraria as a consultant/advisor from Amgen, AstraZeneca, Boehringer Ingelheim, Edwards Lifescience, Esperion, Medtronic, Merck, Novartis, Novo Nordisk, New Amsterdam, and Pfizer; Maya S. Safarova has no interests to declare; Daniel E. Soffer received honoraria from Ionis, Amryt, and Endless Health for advisory committee membership, from Novartis as a consultant, and from Amgen for research monitoring committee membership, and received fees from Amryt as a principal investigator in a clinical trial and from a PCORI grant as an investigator in a clinical trial, and has served without compensation as a consultant to GENinCode, as an advisor to Endless Health, and as a subinvestigator in a clinical trials for Amgen, Ionis, Novartis, and Verve; Pam R. Taub received consulting fees from Amgen, Boehringer Ingelheim, Novartis, Novo Nordisk, Medtronic, Jazz, Sanofi, Merck, Edwards, Esperion, and Lexicon as a consultant; Michael J. Wilkinson received research support from Amgen for an investigator-initiated study (closed) and consulting fees from Amarin and Kaneka as a consultant, from Regeneron as a consultant and speaker, from the Kinetix Group as a consultant (ended), and from Novartis for advisory board membership (ended) and through an institutional consulting agreement paid to his institution for advising on research; Don P. Wilson received a consulting fee from Alexion for advisory board membership; Christie M. Ballantyne received grant/research support (through his institution) from Abbott Diagnostic, Akcea, Amgen, Arrowhead, Eli Lilly, Ionis, Merck, New Amsterdam, Novartis, Novo Nordisk, Regeneron, and Roche Diagnostic for contracted research and consulting fees from Abbott Diagnostic, Alnylam Pharmaceuticals, Amgen, Arrowhead, Astra Zeneca, Denka Seiken, Eli Lilly, Esperion, Genentech, Illumina, Ionis, Merck, New Amsterdam, Novartis, Novo Nordisk, Roche Diagnostic, and TenSixteen Bio as a consultant.
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