Fig. 4.

Mitigation of Lp(a)-associated risk in patients with ASCVD. Patients with high Lp(a) and ASCVD should be categorized as being a high risk for future CVD event(s). As per the Central Illustration, adoption of “Life's Essential 8″ should be advised with initial risk mitigation discussions. Further understanding of the pro-atherogenic, pro-inflammatory and pro-thrombotic burden of Lp(a)-associated ASCVD risk should prompt consideration of the armamentarium of therapies that can mitigate risk (including lipid-lowering therapies and/or lipoprotein apheresis, and anti-inflammatory, anti-platelet and/or anti-coagulant therapies) with consideration of a referral to a specialist (eg, lipidologist or preventive cardiologist). Therapies in bold indicate those where current evidence suggests a clinical benefit could be derived in patients with high Lp(a).

*Anti-PCSK9 mAbs or PCSK9 siRNA therapies; ^†lipoprotein apheresis is currently FDA-approved for patients with high Lp(a) only in the setting of FH. FH = familial hypercholesterolemia; P2Y12 = purinergic receptor P2Y G-protein-coupled 12.