Lipoprotein(a) as an Independent Cardiovascular Risk Factor: Current Evidence and Therapeutic Perspectives – A Narrative Review

Cardiovascular diseases remain a major global public health challenge despite substantial advances in diagnosis and treatment. The occurrence of cardiovascular events in patients with well-controlled traditional risk factors highlights the need to identify additional determinants of risk. Lipoprotein(a) [Lp(a)] is a distinct lipoprotein fraction whose plasma concentration is largely genetically determined and remains relatively stable throughout life. An increasing body of evidence indicates that Lp(a) is an independent risk factor for coronary artery disease, ischemic stroke, and calcific aortic valve stenosis, owing to its atherogenic, proinflammatory, and prothrombotic properties. Lp(a) measurement is gaining importance in cardiovascular risk assessment; however, its use in routine clinical practice remains limited. Management of patients with elevated Lp(a) concentrations currently relies primarily on intensive control of other cardiovascular risk factors, particularly low-density lipoprotein (LDL) cholesterol. The development of RNA-based therapies offers the prospect of targeted Lp(a) lowering. This review provides a comprehensive overview of current knowledge on the biology, clinical significance, diagnosis, and therapeutic options related to lipoprotein(a) and discusses its emerging role in cardiovascular risk stratification and precision medicine.