A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice
•Lp(a) level should be measured at least once in all adults.•Lp(a) levels represent a continuum of risk, not a risk threshold at a dichotomous cutpoint.•Risk classification by Lp(a) level ranges from low (
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| Veröffentlicht in: | Journal of clinical lipidology 2024-05, Vol.18 (3), p.e308-e319 |
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| container_title | Journal of clinical lipidology |
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| creator | Koschinsky, Marlys L. Bajaj, Archna Boffa, Michael B. Dixon, Dave L. Ferdinand, Keith C. Gidding, Samuel S. Gill, Edward A. Jacobson, Terry A. Michos, Erin D. Safarova, Maya S. Soffer, Daniel E. Taub, Pam R. Wilkinson, Michael J. Wilson, Don P. Ballantyne, Christie M. |
| description | •Lp(a) level should be measured at least once in all adults.•Lp(a) levels represent a continuum of risk, not a risk threshold at a dichotomous cutpoint.•Risk classification by Lp(a) level ranges from low ( |
| doi_str_mv | 10.1016/j.jacl.2024.03.001 |
| format | Article |
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Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention.
[Display omitted]</description><identifier>ISSN: 1933-2874</identifier><identifier>EISSN: 1876-4789</identifier><identifier>DOI: 10.1016/j.jacl.2024.03.001</identifier><identifier>PMID: 38565461</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiovascular disease ; Cardiovascular Diseases - blood ; Cardiovascular Diseases - prevention & control ; Guidelines ; Humans ; Hypolipidemic Agents - therapeutic use ; Lipoprotein(a) ; Lipoprotein(a) - blood ; Prevention ; Risk assessment ; Risk Factors ; Scientific statements ; Treatment practice</subject><ispartof>Journal of clinical lipidology, 2024-05, Vol.18 (3), p.e308-e319</ispartof><rights>2024 National Lipid Association</rights><rights>Copyright © 2024 National Lipid Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-1eb0a37c4a7485bc52aabee96d08bd4491077a01fa2b460ef2008dae593b59013</citedby><cites>FETCH-LOGICAL-c356t-1eb0a37c4a7485bc52aabee96d08bd4491077a01fa2b460ef2008dae593b59013</cites><orcidid>0000-0002-2815-4816 ; 0000-0001-7560-9521 ; 0000-0002-3800-7369 ; 0000-0002-8557-7225 ; 0000-0003-1211-3064 ; 0000-0002-0684-0655 ; 0000-0002-9926-2179 ; 0000-0001-7397-6520</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1933287424000333$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38565461$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koschinsky, Marlys L.</creatorcontrib><creatorcontrib>Bajaj, Archna</creatorcontrib><creatorcontrib>Boffa, Michael B.</creatorcontrib><creatorcontrib>Dixon, Dave L.</creatorcontrib><creatorcontrib>Ferdinand, Keith C.</creatorcontrib><creatorcontrib>Gidding, Samuel S.</creatorcontrib><creatorcontrib>Gill, Edward A.</creatorcontrib><creatorcontrib>Jacobson, Terry A.</creatorcontrib><creatorcontrib>Michos, Erin D.</creatorcontrib><creatorcontrib>Safarova, Maya S.</creatorcontrib><creatorcontrib>Soffer, Daniel E.</creatorcontrib><creatorcontrib>Taub, Pam R.</creatorcontrib><creatorcontrib>Wilkinson, Michael J.</creatorcontrib><creatorcontrib>Wilson, Don P.</creatorcontrib><creatorcontrib>Ballantyne, Christie M.</creatorcontrib><title>A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice</title><title>Journal of clinical lipidology</title><addtitle>J Clin Lipidol</addtitle><description>•Lp(a) level should be measured at least once in all adults.•Lp(a) levels represent a continuum of risk, not a risk threshold at a dichotomous cutpoint.•Risk classification by Lp(a) level ranges from low (<75 nmol/L) to high (≥125 nmol/L).•Lp(a) risk categories apply across races and ethnicities.•High Lp(a) levels warrant early and more-intensive risk factor management.
Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention.
[Display omitted]</description><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - blood</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Guidelines</subject><subject>Humans</subject><subject>Hypolipidemic Agents - therapeutic use</subject><subject>Lipoprotein(a)</subject><subject>Lipoprotein(a) - blood</subject><subject>Prevention</subject><subject>Risk assessment</subject><subject>Risk Factors</subject><subject>Scientific statements</subject><subject>Treatment practice</subject><issn>1933-2874</issn><issn>1876-4789</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMofv8BD5KjHlonn23ByyJ-waIXPYc0nWKWblObVPDf23XVo6eZgWdeZh5CzhjkDJi-WuUr67qcA5c5iByA7ZBDVhY6k0VZ7c59JUTGy0IekKMYVwBKFaD2yYEolVZSs0PiFrQNborY0GlobEKaAk1vSDmwij4tFzQ6j33yrXc0phlYzxMNPZ13aGhp54cwjCGh7y_sJfU9dZ3vvbMdHUbrknd4QvZa20U8_anH5PXu9uXmIVs-3z_eLJaZE0qnjGENVhRO2kKWqnaKW1sjVrqBsm6krBgUhQXWWl5LDdhygLKxqCpRqwqYOCYX29z5nvcJYzJrHx12ne0xTNEIEExrxiuYUb5F3RhiHLE1w-jXdvw0DMxGrlmZjVyzkWtAGPjOP__Jn-o1Nn8rvzZn4HoL4Pzlh8fRfMtz2PgRXTJN8P_lfwGwPInA</recordid><startdate>202405</startdate><enddate>202405</enddate><creator>Koschinsky, Marlys L.</creator><creator>Bajaj, Archna</creator><creator>Boffa, Michael B.</creator><creator>Dixon, Dave L.</creator><creator>Ferdinand, Keith C.</creator><creator>Gidding, Samuel S.</creator><creator>Gill, Edward A.</creator><creator>Jacobson, Terry A.</creator><creator>Michos, Erin D.</creator><creator>Safarova, Maya S.</creator><creator>Soffer, Daniel E.</creator><creator>Taub, Pam R.</creator><creator>Wilkinson, Michael J.</creator><creator>Wilson, Don P.</creator><creator>Ballantyne, Christie M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2815-4816</orcidid><orcidid>https://orcid.org/0000-0001-7560-9521</orcidid><orcidid>https://orcid.org/0000-0002-3800-7369</orcidid><orcidid>https://orcid.org/0000-0002-8557-7225</orcidid><orcidid>https://orcid.org/0000-0003-1211-3064</orcidid><orcidid>https://orcid.org/0000-0002-0684-0655</orcidid><orcidid>https://orcid.org/0000-0002-9926-2179</orcidid><orcidid>https://orcid.org/0000-0001-7397-6520</orcidid></search><sort><creationdate>202405</creationdate><title>A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice</title><author>Koschinsky, Marlys L. ; 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Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention.
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| subjects | Cardiovascular disease Cardiovascular Diseases - blood Cardiovascular Diseases - prevention & control Guidelines Humans Hypolipidemic Agents - therapeutic use Lipoprotein(a) Lipoprotein(a) - blood Prevention Risk assessment Risk Factors Scientific statements Treatment practice |
| title | A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice |
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