Lipoprotein (a): epidemiology, pathophysiology, measurement issues and clinical management.

Lipoprotein (a) [Lp(a)], a circulating low-density lipoprotein particle, was discovered in 1963. Since then, knowledge about the Lp(a) pathophysiology and its role on atherosclerotic cardiovascular disease and aortic valve stenosis have progressively expanded. Lp(a) measurement is recommended once in a patient's lifetime, particularly in Familial Hypercholesterolemia subjects, but also as part of the initial lipid screening to assess cardiovascular risk. The apo(a) size polymorphism represents a challenge for Lp(a) measurement in plasma, but advancements in diagnostic testing are overcoming these difficulties. In clinical practice, high Lp(a) concentration should be interpreted as an independent cardiovascular risk factor, also useful for absolute global cardiovascular risk assessment. Until now, no pharmacological treatments were available to selectively lower Lp(a), only LDL plasma apheresis moderately reduce Lp(a) levels in conjunction with PCSK9 inhibitor treatment. The antisense oligonucleotide directed to apo(a) configures as a new therapeutic promise. [ABSTRACT FROM AUTHOR]