How does lipoprotein (a) affect the risk for coronary artery disease (CAD)?

Updated: Mar 30, 2020
  • Author: F Brian Boudi, MD, FACP; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

An elevated lipoprotein(a) [Lp(a)] level is an independent risk factor of premature CAD [49] and is particularly a significant risk factor for premature atherothrombosis and cardiovascular events. Measurement of Lp(a) is more useful for young individuals with a personal or family history of premature vascular disease and repeat coronary interventions. The 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults states that, in asymptomatic intermediate-risk adults, lipoprotein-associated phospholipase A2 might be reasonable for cardiovascular risk assessment. [16]

Lp(a) may be used to identify people at increased cardiovascular risk, but as of yet, there have been no studies on Lp(a) lowering because of the lack of available agents that are effective in reducing this value. Therefore, low-density lipoprotein (LDL) lowering is probably the best strategy in people with elevated Lp(a) levels. [3]

In patients with genetically confirmed heterozygous familial hypercholesterolemia, the presence of elevated levels of lipoprotein(a), hypertension, and renal insufficiency appear to be independent predictors of CAD beyond elevated pretreatment  low-density lipoprotein (LDL)-cholesterol. [52]


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