7 Elevated Lp(a): What Are the Risks? People who have clinical CVD (including atherosclerosis-based cardiovascular diseases (ASCVD) such as acute coronary syndrome; stable angina or a history of MI or coronary or other arterial revascularization; stroke or transient ischemic attack; or PAD, including aortic aneurysm), are at higher risk for future events if Lp(a) is elevated. Elevated Lp(a) is also associated with onset14,15 and progression14 of CAVD, and progression to symptomatic heart failure.16 In the general population, Lp(a) levels greater than 50 mg/dL (~125 nmol/L) are associated with an approximately 20% increased risk of cardiovascular events: each 3.5-fold increase in Lp(a) is associated with a 16% increase of risk of events.20* People with borderline or slightly elevated LDL-C are three to four times more likely to have CVD events than those with low LDL-C.21 Lp(a) can pose increased risk for acute coronary syndrome when LDL-C is elevated.22** * Treatment strategy: Consider implementation of aggressive LDL-C lowering strategies in patients with elevated Lp(a). ** Treatment strategy: Maximally manage treatable risk factors in patients with elevated Lp(a). Lp(a): A Toolkit for Health Care Professionals In people with established CVD, elevated Lp(a) levels significantly increase the risk of future cardiovascular events, particularly in those with LDL-C ≥ 130 mg/dL.19 Elevated Lp(a) seems to be associated with atherosclerotic renal artery stenosis in hypertensive patients with low LDL-C.17 Elevated Lp(a) values represent an independent risk factor for ischemic stroke (more relevant in patients who have a stroke at a young age), PAD and aortic and mitral valve stenosis.18 Of Note … Patients with elevated Lp(a) are at risk even if their LDL-C is optimally controlled by statins.6 In particular, residual risk conferred by Lp(a) for a recurrent event is about 10% even when statins and other lipid-lowering therapies (i.e., PCSK9 inhibitors) are used to lower LDL-C.23
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