Table 1.

Summary of major society guidelines and scientific statement recommendations on Lp(a) testing.

	When to measure Lp(a)	Class/LOE	Threshold of Lp(a)	Class/LOE
2018 ACC/AHA Cholesterol Guidelines	Family history of premature ASCVD or personal history of ASCVD	N/A	Lp(a) ≥ 50 mg/dL or 125 nmol/L as a risk enhancing factor that favor initiation of statin therapy in adults 40 to 75 years of age without diabetes mellitus and 10-year ASCVD risk of 7.5 %−19.9 %	N/A
2019 NLA Scientific Statement on Use of Lipoprotein(a) in Clinical Practice	Reasonable to refine risk assessment for ASCVD events in 1) individuals with a family history of first-degree relatives with premature ASCVD), 2) individuals with premature ASCVD in absence of traditional risk factors, 3) primary severe hypercholesterolemia or suspected FH, 4) individuals at very-high-risk of ASCVD to better define those who are more likely to benefit from PCSK9 inhibitor therapy.	IIa/B-NR for all indications (except LOE C-LD for #1)	When Lp(a) values are used for ASCVD risk assessment in Caucasian patients, it is reasonable to use measured values ≥ 50 mg/dL or 100 nmol/L as levels suggesting increased risk	IIa/B-R
	May be reasonable for individuals with: 1) intermediate 10-y ASCVD risk when decision to use a statin is uncertain, to improve risk stratification in primary prevention, 2) borderline 10-y ASCVD risk when the decision to use a statin is uncertain, to improve risk stratification in primary prevention, less-than-anticipated LDL-C lowering, despite good adherence to therapy, 4) a family history of elevated Lp(a), 5) calcific valvular aortic stenosis, 6) recurrent or progressive ASCVD despite optimal lipid-lowering therapy	IIb for all B-NR for # 1 and 2 C-LD for #3–6	–	–
2019 ESC/EAS Guidelines for Management of Dyslipidemias	Lp(a) measurement should be considered at least once in each adult person's lifetime to identify those with very high inherited Lp(a) levels >180 mg/dL (>430 nmol/L) who may have a lifetime risk of ASCVD equivalent to the risk associated with heterozygous FH.	IIa/C	–	–
	Lp(a) should be considered in selected patients with a family history of premature CVD, and for reclassification in people who are borderline between moderate and high risk	IIa/C	–	–
2019 HEART UK Consensus Statement on Lipoprotein(a)	1) Personal or family history of premature atherosclerotic CV disease, first degree relatives 2) with raised serum Lp(a) levels (> 200 nmol/l), familial hypercholesterolemia or other genetic dyslipidemias, 3) calcified aortic valve stenosis, 4) a borderline increased (but <15 %) 10-year risk of CV event	N/A	CV risk conferred by Lp(a) is 32–90 nmol/L minor, 90–200 nmol/L moderate, 200–400 nmol/l high, >400 nmol/l very high. The management of raised Lp(a) levels (>90 nmol/L) should include reducing overall atherosclerotic risk, controlling hyperlipidemia, considering lipoprotein apheresis.	N/A
2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia	Once in patient's lifetime, with initial screening.	N/A	Presence of risk modifier, including Lp(a) ≥ 50 mg/dL (≥ 100 nmol/L), in intermediate-risk individuals favors the use of statins.	N/A

LOE=level of evidence, ACC=American College of Cardiology, AHA=American Heart Association, ASCVD=atherosclerotic cardiovascular disease, NLA=National Lipid Association, FH=familial hypercholesterolemia, ESC=European Society of Cardiology, EAS=European Atherosclerosis Society, CV=cardiovascular.