Expert Consensus on Lipoprotein(a) in the Gulf Countries: Navigating Cardiovascular Risk and Therapeutic Advances

Lipoprotein(a) [Lp(a)] is increasingly recognized as an independent and causal risk factor for atherosclerotic cardiovascular (CV) disease including aortic valve stenosis, myocardial infarction, stroke, peripheral arterial disease and CV death. Despite growing global awareness, significant gaps in diagnosis, risk stratification, and management persist in Gulf countries. To develop regionally tailored consensus statements on the clinical management of elevated Lp(a) in Gulf countries using a modified Delphi-based methodology. A multidisciplinary panel, mostly of Gulf-based experts in cardiology, lipidology, and endocrinology evaluated 64 evidence-based statements across six thematic domains, including pathophysiology, risk assessment, therapeutic strategies, and implementation challenges. Consensus was defined by ≥80% agreement, and relevant literature was reviewed to support each statement. Strong consensus supported the inclusion of Lp(a) in routine CV risk assessment, especially for high-risk individuals. The panel endorsed early detection and aggressive management of modifiable risk factors, including LDL-C, apoB, and non-HDL-C. Areas of partial agreement highlighted practical challenges, including variability in insurance coverage and the need for clearer referral pathways, imaging protocols, and outcome-driven treatment guidance and particularly the current unavailability of specific Lp(a) lowering drugs. These expert recommendations provide a pragmatic framework for integrating Lp(a) into CV care pathways in Gulf countries. By aligning practice with emerging evidence, the consensus has the potential to shape national guidelines, inform payer policies, promote regional research on the epidemiology of Lp(a), and support equitable access to future Lp(a)-targeted therapies, ultimately improving long-term CV outcomes in the region. • Lp(a) is a causal and independent risk factor for ASCVD • Lp(a) levels are largely genetically determined and stable over life • One-time Lp(a) testing recommended, especially in high-risk individuals • Elevated Lp(a) should prompt referral for specialized ASCVD risk evaluation • Lack of regional data may underestimate risk in Middle Eastern populations