Lipoprotein(a) and cardiovascular risk: A roadmap for patient management

Lipoprotein(a) [Lp(a)] is a plasma lipoprotein that shares structural elements with low-density lipoprotein (LDL), such as apolipoprotein B-100 (apoB), but differs by the presence of apolipoprotein(a) [apo(a)], which is covalently linked to apoB via a disulphide bond. In recent years, interest in Lp(a) has increased considerably, as epidemiological, genetic and biological evidence supports its causal role in cardiovascular disease. Its heterogeneous structural features, metabolic peculiarities, and ability to transport biologically active and potentially pro- atherogenic, pro-inflammatory and pro-thrombotic molecules make Lp(a) a unique lipoprotein among the apoB-containing lipoproteins. Lp(a) is now recognised as an important risk factor in cardiovascular risk assessment, as it plays a causal and independent role in the development of both atherosclerotic disease and aortic valve stenosis. Measuring Lp(a), together with other determinants of cardiovascular risk, is now recognised as essential for appropriate clinical management and the identification of new therapeutic targets. Consequently, the need to include Lp(a) in global cardiovascular risk assessment has clearly emerged, especially in individuals with a personal history of early or recurrent events, familial hypercholesterolaemia, family history of early events, or family history of high Lp(a) levels. This document, produced through the collaboration of the main Italian scientific societies in the field of cardiovascular disease management and laboratory medicine (SISA, SIC, ANMCO and SIBioC), analyses the pathogenetic role of lipoprotein(a) [Lp(a)] and the clinical significance of its measurement.