Lipoprotein(a) - gaining clinical importance as a cardiovascular risk factor. Current state of medical knowledge.

Cardiovascular disease has been a major cause of human mortality worldwide for many decades. One of the risk factors for atherosclerosis that is gaining clinical importance is serum lipoprotein(a) (Lp(a)) concentration. The purpose of this publication is to present current knowledge regarding Lp(a) and currently available investigational drugs that reduce serum Lp(a). We also present current recommendations for interventions aimed at reducing the cardiovascular risk associated with high serum Lp(a) concentration. Lipoprotein(a) is a variant of low-density lipoprotein (LDL) containing an additional glycopeptide chain called apolipoprotein(a) (apo(a)) covalently linked to apolipoprotein B-100 (apoB-100). Increased serum Lp(a) is a well-established independent risk factor for atherosclerosis and aortic stenosis. Unlike LDL-cholesterol (LDL-C) concentration, serum Lp(a) does not decrease significantly as a result of recommended lifestyle changes nor as a result of the use of major hypocholesterolemic drug classes. Approximately 20% of people worldwide have high serum Lp(a). Current recommendation is to perform a screen for serum Lp(a) at least once in one’s lifetime in general population. Effective lowering of serum Lp(a) falls into the category of urgent unmet medical needs. In the absence of effective drugs to reduce serum Lp(a) in individuals with elevated Lp(a), intensified control of other cardiovascular risk factors and in extreme cases therapeutic apheresis are strongly recommended.