What the clinical cardiologist should know about lipoprotein (a)?

Abstract

Elevated lipoprotein (a) [Lp(a)] is a non-traditional, independent vascular risk factor for cardiovascular disease and calcified aortic valve stenosis. It is one of the main inherited dyslipidemia in patients with early coronary heart disease.
Its structure is similar to LDL cholesterol, with the main structural difference between them being that Lp(a) has a second protein called apolipoprotein (a).
In this work, we analyze the prothrombotic and proatherogenic properties of Lp(a), which by different pathophysiological mechanisms have a direct influence on the development, progression and evolution of cardiovascular diseases.
We review the main scientific evidence emerged from population and genetic studies on Lp(a) that demonstrate its role as a causal factor in the development of cardiovascular disease.
Practical recommendations for the management of Lp(a) are considered, with special emphasis made on patient groups that benefit from its determination and on the reasons why the identification of high Lp(a) implies a change in the management of primary or secondary prevention of these patients.
Finally, we address the available therapeutic measures and those currently under review. We highlight the concept of reducing global cardiovascular risk and the role of elevated Lp(a) in its reclassification, and in the intensification of preventive measures at each level of vascular risk.