Lipoprotein(a)—It Is Risky, but What Do We Do About It?

Abstract

Lipoprotein(a) [Lp(a)] is a pro-inflammatory, pro-thrombotic, and pro-atherogenic lipoprotein particle. Lp(a) binds and transports oxidized phospholipids in the bloodstream. It is one of the strongest genetic risk factors for coronary artery disease, stroke, and calcific aortic valve stenosis. Elevated Lp(a) levels, or hyperlipoproteinemia(a), is associated with cardiovascular outcomes even in high-risk individuals who achieve their low-density lipoprotein cholesterol target with statins. Lifestyle modification therapy and dietary supplements have little impact on plasma Lp(a) levels. However, in individuals with hyperlipoproteinemia(a), the adherence to ideal cardiovascular health metrics (not smoking, having a healthy diet, being physically active, having a normal body mass index, having a normal blood pressure as well as blood sugar and cholesterol levels) might reduce the cardiovascular risk associated with elevated Lp(a) levels. Cardiovascular drugs such as proprotein convertase subtilisin/kexin type 9 inhibitors and niacin provide modest reductions in Lp(a) levels. Lp(a)-targeted therapies are currently being developed, and their impact on cardiovascular risk is yet to be determined. In the absence of approved Lp(a)-targeted therapies, a holistic approach combining strict control of traditional cardiovascular risk factors and the adequate management of lifestyle-related risk factors is likely to significantly reduce cardiovascular risk in patients with hyper-Lp(a).