Rationale for the routine screening of Lipoprotein(a) in cardiovascular risk assessment

Lipoprotein(a) [Lp(a)] is a lipid particle identified by Mendelian randomization studies to be causally associated with the development of atherosclerotic cardiovascular disease and aortic stenosis, across ethnicities. The risk of cardiovascular disease with markedly elevated Lp(a) is equal to that of untreated familial hypercholesterolemia, and yet, up until now, there has been hesitancy in measuring Lp(a) as a routine part of cardiovascular risk assessment. Screening of Lp(a) level in all individuals is now recommended in the European and Canadian Lipid Guidelines and by the National Lipid Association. This review assesses how well measurement of Lp(a) meets accepted criteria for population screening of an analyte, based on established principles used for the selection of a new candidate for inclusion in screening programs. Lp(a) meets the majority of recommended principles for a routine population screening test, based on health, societal, and cost considerations. Incorporating Lp(a) into global assessment and management of cardiovascular risk will result in savings to health care systems, reinforce recommendations from growing numbers of clinical guidelines and consensus statements, and increase implementation of proactive preventive medicine.