17 Lp(a) and PAD Toolkit: Emerging Diagnosis and Management Diet and exercise have not been shown to reduce Lp(a) levels.5, 12 Treat modifiable risk factors Medical therapy and lifestyle changes include targeting diabetes (enhanced glucose control), smoking cessation, treating HTN and/or high LDL-C, sustained weight loss, and increasing physical activity.6 Initiate or increase statin intensity if elevated Lp(a), even if LDL-C is at goal. Lp(a) lowering is difficult, but proven therapies for ASCVD prevention should be implemented. Lp(a) levels are 80-90% genetically influenced. 6 Cascade screening of family members of a patient with high Lp(a) will identify elevated Lp(a) in family members. This allows affected family members to learn they have a hidden ASCVD risk factor, and provides an opportunity for them to intensify ASCVD preventive interventions.12 Follow the Guidelines 2019 AHA/ACC primary prevention of CVD.6 An Lp(a) ≥50 mg/dL or ≥125 nmol/L is considered a risk-enhancing factor.12
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