# Lp(a) in the Horizon of Diagnostics and Therapy

## TL;DR

Lp(a) is a genetic cardiovascular risk factor not captured by traditional cholesterol tests, and its role in heart disease is increasingly recognized.

## Contribution

This paper reviews the pathophysiological mechanisms of Lp(a) and emphasizes the need for standardized measurement and targeted therapies.

## Key findings

- Elevated Lp(a) levels are linked to increased risk of atherosclerotic cardiovascular diseases.
- Lp(a)'s effects include pro-atherogenic, pro-inflammatory, and pro-thrombotic mechanisms.
- Standardized Lp(a) measurement is crucial for accurate risk assessment and treatment.

## Abstract

Low-density lipoprotein cholesterol (LDL-C) has traditionally been the primary biomarker used to assess cardiovascular risk. However, a substantial proportion of cardiovascular events occur in individuals with LDL-C levels within the normal range, highlighting the need for additional risk markers. Lipoprotein(a) [Lp(a)] has emerged as an independent and genetically determined cardiovascular risk factor that is not adequately captured by conventional lipid profiling. Elevated Lp(a) levels are associated with an increased risk of atherosclerotic cardiovascular disease, including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis, and appear to be particularly relevant in the context of premature cardiovascular events. The pathogenicity of Lp(a) is driven by distinct mechanisms that extend beyond cholesterol transport. These include pro-atherogenic, pro-inflammatory, and pro-thrombotic effects mediated largely by oxidized phospholipids carried by the particle and by the structural properties of apolipoprotein(a), which interfere with fibrinolysis. Despite its strong and stable genetic determination, Lp(a) remains underrecognized and inconsistently measured in clinical practice, partly due to historical limitations in assay standardization and reporting. This minireview summarizes current knowledge on the pathophysiological mechanisms underlying elevated Lp(a), discusses its clinical implications for cardiovascular risk assessment, and highlights the importance of standardized Lp(a) measurement in routine practice, particularly in light of emerging Lp(a)-targeted therapies.