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The dedicated “Lp(a) clinic”: A concept whose time has arrived?

  • Sotirios Tsimikas
    Correspondence
    Corresponding author. Sulpizio Cardiovascular Center, University of California San Diego, 9500 Gilman Drive, BSB 1080, La Jolla, CA, 92093-0682, USA.
    Affiliations
    Vascular Medicine Program, Sulpizio Cardiovascular Center, Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
    Search for articles by this author
  • Erik S.G. Stroes
    Affiliations
    Vascular Medicine Program, Sulpizio Cardiovascular Center, Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA

    Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
    Search for articles by this author

      Highlights

      • Lp(a) is a causal risk factor for cardiovascular disease (CVD) and calcific aortic valve disease.
      • Novel Lp(a) lowering approaches have re-invigorated clinical interest in Lp(a).
      • Elevated Lp(a) (>50 mg/dL) is estimated to be present in >1.4 billion people.
      • Patients with elevated Lp(a) are significantly under-diagnosed.
      • A rationale of an outpatient “Lp(a) clinic” is presented.

      Abstract

      The emergence of pathophysiological, epidemiologic, and genetic data strongly supports the causality for lipoprotein(a) [Lp(a)] in cardiovascular disease (CVD) and calcific aortic valve disease (CAVD). In parallel, novel Lp(a) lowering approaches have been developed that have re-invigorated clinical interest in Lp(a). Because Lp(a) is the most prevalent monogenetic lipid disorder globally, with prevalence of Lp(a) > 50 mg/dL estimated at >1.4 billion people, the rationale for diagnosing and managing Lp(a)-mediated risk is now stronger than ever. Patients with elevated Lp(a) are significantly under-diagnosed and the diagnosis is frequently made ad hoc rather than systematically. Elevated Lp(a) levels are associated with atherothrombotic risk and patients present with varied clinical phenotypes, ranging from stroke in pediatric age groups, to ST-segment elevation myocardial infarction in young males, to CAVD in elderly individuals. A new clinical care paradigm of a dedicated “Lp(a) Clinic” would serve to evaluate and manage such patients who have elevated Lp(a) as the pathophysiological etiology. Such a clinic would include multidisciplinary expertise in lipid metabolism, clinical cardiology, vascular medicine, valvular disease, thrombosis, and pediatric aspects of clinical care. This viewpoint argues for the rationale of an Lp(a) outpatient clinic where patients with elevated Lp(a) and their affected relatives can be referred, evaluated, managed and followed, to ultimately reduce Lp(a)-mediated CVD and CAVD risk.

      Keywords

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