What are the new scientific indications on Lipoprotein A and cardiovascular risk?
It is a silent enemy of the heart and blood vessels. Less known, but probably no less dangerous, than other risk factors more often put in the spotlight, such as high levels of LDL cholesterol, triglycerides, blood sugar or blood pressure. We are talking about lipoprotein A (Lp(a)), which is responsible for cholesterol transport in the blood: at high concentrations it poses a danger in terms of atherosclerotic cardiovascular disease and aortic valve stenosis. A consensus document from the European Atherosclerosis Society reminds us of this today, which a decade after a statement on Lp(a) returns to the issue, with some fine-tuning. The goal is to provide clinical guidance for testing and treating elevated levels of Lp(a)-a condition that affects more than 20 percent of the general population, and even more so individuals with coronary artery disease-and to include the results of this analysis in estimating global cardiovascular risk.
Increased cardiovascular risk
The starting point, says the study published in October in the European Heart Journal, whose authors include Alberico Catapano of the Department of Pharmacology at the University of Milan, is the strong evidence for a causal association between Lp(a) concentrations and cardiovascular outcomes. What is new is the concept of the risk threshold, which is highlighted in this new document. In practice, therefore, cardiovascular risk increases as Lp(a) concentration increases in both men and women.
Measuring lipoprotein A
A second important message emphasized by the new study is that Lp(a) interacts with other factors in increasing overall cardiovascular risk. In other words, this is higher in people with high Lp(a) levels and a low cardiovascular health score, compared with those who still have high Lp(a) levels but generally good cardiovascular health. Therefore, the key message of the European Atherosclerosis Society paper, is that it is important that lipoprotein be measured at least once in adults through specific tests.
A guide for physicians
There are not yet any specific therapies for this condition, although some molecules are in phase II/III clinical trials. Therefore, the consensus document points out that it is important for physicians to have clear guidance on how to manage the excess risk associated with high Lp(a) concentration. Previous guidelines recommended acting on risk factors, but did not provide specific information on how to tailor interventions for the individual patient. Instead, the new statement is a guide for optimal management of the risk associated with lipoprotein A by also considering the other major risk factors, for example by acting on LDL cholesterol reduction or with interventions on blood pressure. Always remembering that the earlier the intervention is started, the greater the impact on cardiovascular risk over a lifetime.