15 The Importance of Shared Decision-Making Clinicians and patients should work together to make informed decisions based on the patient’s overall cardiovascular risk, values and preferences. Consider these important factors: z Explain that Lp(a) is largely genetically determined, generally stable over the life course, and independently associated with ASCVD risk. z Discuss how the patient’s Lp(a) level modifies overall ASCVD risk and may support earlier or more intensive LDL-C lowering and management of other modifiable cardiovascular risk factors. z Review treatment options and goals, distinguishing therapies used to reduce overall ASCVD risk from Lp(a)-specific therapies that remain under investigation. z Discuss the implications of elevated Lp(a) for family members and the role of cascade testing in first-degree relatives. z Encourage patients to discuss their values, preferences, concerns and personal goals, including medication burden, cost and potential adverse effects. z Use a guide to facilitate shared decision-making with the patient.4 Of Note… Evidence indicates that measuring Lp(a) may reclassify CVD risk and aid in pharmacotherapy decision-making. Lp(a) levels are predominantly genetically determined and generally stable over time; therefore, a single measurement is usually sufficient. Repeat measurement may be considered in selected circumstances.4 Lp(a): A Toolkit for Healthcare Professionals z Access to the American Heart Association’s Lp(a) Discussion Guide at heart.org/lpa
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