Bundled measurement of LDL-cholesterol, lipoprotein(a), and high sensitivity C-reactive protein across the spectrum of cardiovascular risk

In the era of the Predicting Risk of Cardiovascular Disease (CVD) EVENTs (PREVENT) equations, recalibrating definitions for low, borderline, intermediate, and high risk will be of primary importance. Similarly, the cardiovascular-kidney-metabolic construct calls for more robust assessment of residual risk among individuals with clinical CVD. Recent observational studies demonstrate long-term prognostic value of LDL-cholesterol, lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (hsCRP) for the prediction of CVD. These findings support prior randomized clinical trial data demonstrating a benefit of primary prevention statin therapy for individuals with elevated hsCRP, and that elevated Lp(a) and hsCRP are associated with residual CVD risk in those with clinical CVD and well-controlled LDL-C. Overall, such evidence supports universal measurement of LDL-C, Lp(a), and, for most patients, hsCRP across the spectrum of CVD to facilitate earlier lifestyle guidance and more precise allocation of preventive pharmacotherapies.