Detection strategies for elevated lipoprotein(a): will implementation let the genie out of the bottle?

Abstract

Purpose of reviewElevated Lp(a) level is an important causal risk factor for atherosclerotic cardiovascular disease (ASCVD), principally coronary artery disease. Selective testing for Lp(a) is highly recommended in patients at intermediate and high risk for ASCVD. Lp(a) levels are predominantly genetically determined, and this has implications for cascade testing.Recent findingsRecent studies show that cascade testing is effective in identifying elevated Lp(a) in close relatives of probands with high Lp(a). Apart from selective testing and cascade testing as detection strategies, some recent guidelines recommend testing of Lp(a) in all adults at least once in their lifetime and various implementation strategies have been suggested.SummaryHyper-Lp(a) is an important global health problem that can be easily detected. Hyper-Lp(a) meets all the criteria for universal screening except that there is not yet supportive evidence from clinical interventional trials showing a reduction of ASCVD events. The cost-effectiveness of the various detection and implementation strategies need to be further evaluated.

Undiagnosed cardiovascular risk factors including elevated lipoprotein(a) in patients with ischaemic heart disease

“…Similarly, other studies also report that elevated Lp(a) in patients with ASCVD remains underdiagnosed worldwide, despite calls by international guidelines ( 8 ). Moreover, the European and other guidelines have recommended for Lp(a) to be tested at least once during each adult's lifetime ( 8 , 16 ). Current recommendations for hyper-Lp(a) includes adopting healthy lifestyle modifications, and/or pharmacological treatment to target these modifiable cardiovascular risk factors, and intensifying LDL-C targets ( 6 – 8 , 16 – 19 ).…”

“…Despite recommendations by recent international guidelines that all ASCVD patients should have Lp(a) tested (13,(16)(17)(18)(19) and that it is easily measurable by a blood test that does not require fasting, Lp(a) is currently not being routinely tested in Singapore. Similarly, other studies also report that elevated Lp(a) in patients with ASCVD remains underdiagnosed worldwide, despite calls by international guidelines (8). Moreover, the European and other guidelines have recommended for Lp(a) to be tested at least once during each adult's lifetime (8,16).…”

“…Moreover, the European and other guidelines have recommended for Lp(a) to be tested at least once during each adult's lifetime (8,16). Current recommendations for hyper-Lp(a) includes adopting healthy lifestyle modifications, and/or pharmacological treatment to target these modifiable cardiovascular risk factors, and intensifying LDL-C targets (6)(7)(8)(16)(17)(18)(19). Thirdly, our study showed that the lifestyle factors of smoking and good dietary habits were suboptimal in a significant number of patients.…”

“…Multiple international guidelines have now recommended that Lp(a) be measured in all patients with ASCVD ( 5 – 7 ). However, elevated Lp(a) in patients with ASCVD remains underdiagnosed worldwide ( 8 ) and Lp(a) is not routinely measured locally.…”