Lp (a) – The forgotten lipoprotein

Editorials
Patrick Savage
24/04/2024

Take home messages

  • Lp (a) is an underappreciated cardiovascular risk factor with a casual association for the development of atherosclerotic cardiovascular disease.
  • Lp (a) is also associated with other cardiovascular conditions including the development of aortic valve calcification and abdominal aortic aneurysms.
  • Lp (a) testing may have clinical utility in selecting patients who stand to gain enhanced benefit from aspirin for primary prevention.
  • Important new treatments, targeting Lp(a) directly, are under development which may dramatically change the future landscape of preventive cardiology.
Introduction

Lipoprotein (Lp) [a] consists of a low-density lipoprotein (LDL) like moiety bound to a highly glycosylated apolipoprotein (a) particle and an apolipoprotein B-100 particle linked via a single disulfide bond (Figure 1). Since its discovery in 1963 by Kare Berg, Lp(a) has gone relatively unnoticed in cardiovascular (CV) risk reduction algorithms (1). More recently, greater attention has been afforded to Lp(a) with growing evidence suggesting its causality in the development of atherosclerotic cardiovascular disease (ASCVD), culminating in a recent consensus statement published by the ESC (2).