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Guidelines and Lp(a)
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Adult Guidelines


Guideline on the Management of Blood Cholesterol 2018

  • States that elevated levels of Lp(a) are associated with an increased risk for premature ASCVD, and are largely genetically determined.

  • In adults 40 to 75 years of age without diabetes mellitus and 10-year risk of 5%-19.9%, risk-enhancing factors favor initiation of statin therapy. Risk-enhancing factors include family history of premature ASCVD; persistently elevated LDL-C levels ≥160 mg/dl (≥4.1 mmol/L); metabolic syndrome; chronic kidney disease; history of preeclampsia or premature menopause (age <40 years); chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, or chronic HIV); high-risk ethnic groups (e.g., South Asian); persistent elevations of triglycerides ≥175 mg/dl (≥1.97 mmol/L); and, if measured in selected individuals, apolipoprotein B ≥130 mg/dl or ≥2500 nmol/L, high-sensitivity C-reactive protein ≥2.0 mg/L (190 nmol/L), ABI <0.9, and lipoprotein (a) ≥50 mg/dl or 125 nmol/L, especially at higher values of lipoprotein (a).

    Expert Perspective: Other risk-enhancing factors include systemic lupus, and radiation therapy for left breast cancer and other radiation therapies where the left main, left anterior descending, and proximal right coronary artery is in the field.

2018 Cholesterol Clinical Practice Guidelines  - Adults here


Canadian Cardiovascular Society - Nov 2016

  • We suggest that Lp(a) might aid risk assessment in subjects with intermediate FRS or with a family history of premature coronary artery disease (Conditional Recommendation; Moderate-Quality Evidence). Values and preferences. Lp(a) is a marker of CVD risk. Particular attention should be given to individuals with Lp(a) levels > 30 mg/dL for whom CVD risk is increased by approximately twofold. Although no randomized clinical trials are available to support basing treatment decisions solely on the basis of an elevated Lp(a) level, identification of high levels of Lp(a) might be particularly useful for mutual decision-making in intermediate-risk subjects. Moreover, in younger patients who have a very strong family history of premature CVD suspected to be related to atherogenic dyslipidemia but who by virtue of young age, do not meet usual risk criteria for treatment, detection of high Lp(a) might help inform mutual decision-making regarding treatment. Lp(a) is not considered a treatment target and repeat measures are not indicated.

Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult here.


ESC/EAS - Aug 2016


  • Lipoprotein(a) is a low-density lipoprotein to which an additional protein called apolipoprotein(a) is attached.
  • High concentrations of Lp(a) are associated with increased risk of CAD and ischemic stroke and Mendelian randomization studies support a causal role in CVD for Lp(a).
  • At present there is no justification for screening the general population for Lp(a), but it may be considered in patients at moderate risk to refine risk evaluation or in subjects with a family history of early CVD.


Catapano, et al. European Heart Journal (2016) DOI: ehw272 First published online: 27 August 2016


Pediatric Guidelines Dec 2011 
2011 Dec;128 Suppl 5:S213-56. doi: 10.1542/peds.2009-2107C. Epub 2011 Nov 14.


Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report.


In terms of other lipid measurements, (1) most but not all studies have found that measurement of apolipoprotein B and apolipoprotein A-1 for universal screening provides no additional advantage over measuring non-HDL cholesterol, LDL cholesterol, and HDL cholesterol levels, (2) measurement of lipoprotein(a) is useful in the assessment of children with both hemorrhagic and ischemic stroke, (3) in offspring of a parent with premature CVD and no other identifiable risk factors, elevations of apolipoprotein B, apolipoprotein A-1, and lipoprotein(a) have been noted, and (4) measurement of lipoprotein subclasses and their sizes by advanced lipoprotein testing has not been found to have sufficient clinical utility in children at this time (grade B).


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