Opinion
Video
Lp(a) Screening in ASCVD: Clinical Integration
Experts discuss the integration of Lp(a) testing into cardiovascular risk assessment, and refining preventive strategies and statin use in specific groups.
This is a video synopsis/summary of an Insights involving Erin D. Michos, MD, MHS; Michael D. Shapiro, DO; and Jaime Murillo, MD.
Michos discusses the incorporation of lipoprotein(a) (Lp[a]) testing into clinical practice, referencing a 2022 statement from the European Atherosclerosis Society. The emphasis lies on considering Lp(a) levels within the context of a patient’s overall atherosclerotic cardiovascular disease (ASCVD) risk, integrating it with other risk factors. Recommendations are tailored based on the integration of a patient’s 10-year ASCVD risk and Lp(a) levels. Notably, individuals with low predicted 10-year risk but elevated Lp(a) above 250 nmol/L may require more intensive prevention treatment, influencing lifestyle modifications and low-density lipoprotein (LDL) cholesterol control.
Shapiro stresses the additive risk information provided by Lp(a) testing, influencing decisions on statin therapy initiation and personalized prevention strategies. Elevated Lp(a) levels, particularly above 50 mg/dl or 125 nmol/L, may prompt more aggressive LDL cholesterol lowering and consideration of emerging Lp(a)-lowering agents.
Regarding the incorporation of Lp(a) testing, Shapiro advocates for one-time universal screening as a standard component of adult lipid testing. This approach allows Lp(a) levels to guide future ASCVD prevention efforts. Murillo underscores the importance of addressing social determinants of health in screening for hypercholesterolemia. He advocates for a holistic approach, recognizing that clinical factors alone are insufficient. Addressing issues like employment, transportation, and access to information is crucial to improving health care outcomes, particularly in underserved populations.
Video synopsis is AI-generated and reviewed by AJMC® editorial staff.
