Lipoprotein(a) [Lp(a)] is the combination of a low-density lipoprotein-like particle and apoprotein(a).

Levels are genetically determined and vary considerably between individuals, but have a linear relationship with atherosclerotic cardiovascular event rates, with a clinically significant risk at levels >125 nmol/L (0.50 g/L).

The experience of a patient with very high Lp(a) levels (>330 nmol/L [1.50 g/L]) is illustrative, with repeated myocardial infarctions starting at a young age (39 years), despite a healthy lifestyle.

Physicians should screen all adults at least once; a finding of elevated Lp(a) should prompt familial cascade screening, as per familial hypercholesterolemia recommendations.

Current treatment is limited to lipoprotein apheresis, but new treatments are in phase 2 and 3 clinical development, and will likely be available within a few years.

Greater awareness of Lp(a) and more proactive screening is required, especially with the imminent availability of effective treatments that will markedly reduce cardiovascular risk for individuals with high Lp(a) levels.