Why Lp(a) Testing Lagged Behind LDL Cholesterol Screening

In an interview with Pharmacy Times, Dinesh Kalra, MD, MBA, FNLA, FACC, FAHA, chief of cardiology at the University of Louisville School of Medicine and president of the National Lipid Association (NLA), discussed why lipoprotein(a) [Lp(a)] testing has trailed other cardiovascular risk factors and how clinicians can manage elevated levels.

Kalra explained that, unlike low-density lipoprotein (LDL) cholesterol, which professional societies have long recommended testing annually or more often depending on patient risk, Lp(a) has gained prominence in the literature only over the past 10 to 15 years, so its recommendations trail LDL cholesterol's by several decades. In recent years, however, the NLA, the European Society of Cardiology, the European Atherosclerosis Society, and other societies have begun recommending that adults have Lp(a) checked at least once in their lifetime, and the American College of Cardiology and American Heart Association have since made a similar recommendation for all adults. Children may also be tested when there is a strong family history of premature cardiovascular disease or high Lp(a).

On management, Kalra emphasized that Lp(a) is one of several contributors to atherosclerotic cardiovascular disease (ASCVD) risk and that it does not come down with diet and exercise. With Lp(a)-lowering drug trials still playing out, the focus remains on modifiable risk factors. LDL cholesterol stays at the center of those efforts, given its tight link to incident cardiovascular disease and the event reductions seen with LDL lowering in primary and secondary prevention. Kalra also called for more aggressive blood pressure control, noting that risk climbs once systolic pressure passes roughly 120 mm Hg and that a reading of 135/85 mm Hg now counts as stage 1 hypertension, along with tighter glycemic control.

For pharmacists, elevated Lp(a) signals a need for comprehensive risk reduction, often with a statin to reach very low LDL cholesterol, to help offset the particle's risk.