Abstract

Lipoprotein (a) [Lp(a)] is a genetically determined and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve stenosis. Unlike other risk factors, circulating Lp(a) levels are determined early in life and have lifelong stability. This opinion piece advocates the implementation of routine Lp(a) screening in current risk scoring. Identifying individuals with elevated Lp(a) leads to more precise risk strategies, earlier application of long-term preventive interventions targeting modifiable risk factors, and the initial selection of desirable candidates for future Lp(a)-specific therapies. Given that RNA-targeting agents (antisense oligonucleotides and small-interfering RNA [siRNA]) have produced 80 to 95% reductions in Lp(a) levels in phase II and III trials, with cardiovascular outcomes studies set to report results during the timeframe of 2025– 2026, it is highly relevant from a clinical standpoint now. In addition, cascade screening of first-degree relatives will allow the preventive impact to reach other families. With an increasingly personalized preventive approach that places the patient at the center of care, routine measurement of Lp(a) is a simple and cost-effective action step toward identifying inherited CV risk, as well as preparing for when targeted therapies are integrated.

Keywords

screening, lipoprotein, clinical practice, epidemiologic