19 Lipoprotein(a) should be measured at least once. It is a risk enhancer at ≥125 nmol/L (50 mg/dL) (~1.4-fold risk) and confers ≥2-fold risk at ≥250 nmol/L (100 mg/dL), prompting more intensified LDL-C lowering. CAC scoring (men ≥40, women ≥45) can improve risk assessment and guide LDL-C/ non–HDL-C goals, with both absolute score and standardized percentile carrying prognostic value. LDL-lowering therapy is recommended in adults 40–75 years with diabetes, CKD stage 3 or 4, or HIV, regardless of LDL-C level; after age 75, pharmacotherapy can be considered alongside lifestyle interventions. In secondary prevention, a goal of LDL-C <55 mg/dL and non–HDL-C <85 mg/dL is recommended for those at very high risk; most patients with prior ASCVD events will qualify for the <55 mg/dL goal. In patients with persistently elevated triglycerides, statin therapy remains the foundation of pharmacotherapy as an adjunct to lifestyle intervention. 6 7 Lp(a): A Toolkit for Healthcare Professionals Check Out Patient Education Resources at heart.org/lpa 8 9 10
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