Lp(a) screening recommended by European Atherosclerosis Society

16/02/2011

Patients at moderate to high risk of cardiovascular disease should be screened for elevated Lp(a) and take niacin to lower levels to under 50 mg/dL (1.3 mmol/L), according to a consensus statement from the European Atherosclerosis Society (EAS).

Lipoprotein a, or Lp(a) is a type of cholesterol made by the liver that consists of a molecule, apolipoprotein a, attached to LDL cholesterol ("bad" cholesterol). While your LDL can be lowered by diet to some degree, Lp(a) is usually inherited. High levels of Lp(a) increases your risk of atherosclerosis formation and coronary heart disease.

A preview of the EAS statement was announced during the EAS 2010 Congress held in June in Hamburg, Germany, by Dr Børge Nordestgaard (University of Copenhagen, Denmark). He said bringing a patient's Lp(a) level under 50 mg/dL should be a treatment priority, after the management of LDL cholesterol.

It is thought that about 20% of people have plasma Lp(a) levels over 50 mg/dL, with no gender differences, but there are some racial differences, with whites and Asians having lower levels while black and Hispanics generally have somewhat higher levels.

Since lifestyle appears to have little impact on Lp(a) level, the EAS recommends that 1 to 3 g of niacin daily is the best treatment. But it notes that further studies are needed in both primary- and secondary-prevention settings to better define which patients should be targeted for treatment and what the target level of Lp(a) should be.

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