Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

Abstract

Abstract This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do not support Lp(a) as a risk factor for venous thrombotic events and impaired fibrinolysis. Very low Lp(a) levels may associate with increased risk of diabetes mellitus meriting further study. Lp(a) has pro-inflammatory and pro-atherosclerotic properties, which may partly relate to the oxidized phospholipids carried by Lp(a). This panel recommends testing Lp(a) concentration at least once in adults; cascade testing has potential value in familial hypercholesterolaemia, or with family or personal history of (very) high Lp(a) or premature ASCVD. Without specific Lp(a)-lowering therapies, early intensive risk factor management is recommended, targeted according to global cardiovascular risk and Lp(a) level. Lipoprotein apheresis is an option for very high Lp(a) with progressive cardiovascular disease despite optimal management of risk factors. In conclusion, this statement reinforces evidence for Lp(a) as a causal risk factor for cardiovascular outcomes. Trials of specific Lp(a)-lowering treatments are critical to confirm clinical benefit for cardiovascular disease and aortic valve stenosis.

Keywords

Affiliated Institutions

• Brigham and Women's Hospital US
• Western University CA
• LMU Klinikum DE
• University of Milan IT
• Harvard University US
• Copenhagen University Hospital DK
• University of Zurich CH
• University of Cambridge GB
• European Atherosclerosis Society SE
• Université Laval CA
• Royal Perth Hospital AU
• Amsterdam University Medical Centers NL
• Istituti di Ricovero e Cura a Carattere Scientifico IT
• Innsbruck Medical University AT
• University of California, Davis US
• The University of Western Australia AU
• Broad Institute US
• University of Copenhagen DK
• Ludwig-Maximilians-Universität München DE
• Baylor College of Medicine US
• University of Amsterdam NL
• University of Edinburgh GB
• Massachusetts General Hospital US
• British Heart Foundation GB
• University of Kansas Medical Center US
• Inserm FR
• Écologie Marine Tropicale des Océans Pacifique et Indien RE
• MultiMedica IT
• Gentofte Hospital DK
• University Hospital of Zurich CH
• University Hospital of Geneva CH
• Imperial College London GB
• Michael E. DeBakey VA Medical Center US
• Hacettepe University TR
• Universität Innsbruck AT
• Institut Universitaire de Cardiologie et de Pneumologie de Québec CA
• Baylor Scott & White Health US

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