II. Indications

  1. Consider in patients at higher risk of ASCVD, to further risk stratify

III. Physiology

  1. Lipoprotein A is structurally similar to LDL Cholesterol, but with an added group
    1. Added group is Apoprotein A (apolipoprotein A) linked by disulfide bonds to Apolipoprotein B-100
  2. Increased Lipoprotein A plasma levels are associated with an increased risk of ASCVD

IV. Interpretation

  1. Lipoprotein A >50 mg/dl
    1. Associated with an increased Cardiovascular Risk and stroke
  2. Lipoprotein A >70 mg/dl
    1. Associated with high Cardiovascular Risk

V. Efficacy

  1. Moderate association with ASCVD risk, with generally stable levels after age 5 years, and inexpensive to test
    1. Patel (2021) Arterioscl Thromb Vasc Biol 41(1): 465-74 [PubMed]

VI. Management

  1. Lipoprotein A is not lowered by typical Hyperlipidemia Management (e.g. lifestyle, Statins)
  2. Methods that do lower Lipoprotein A levels (but not FDA approved, and no established protocols)
    1. PCSK9 Inhibitors
    2. Lipoprotein Apheresis

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