HEART UK consensus statement on Lipoprotein(a): A call to action

Cegla, Jaimini; Neely, R. D. G.; France, Michael; Ferns, Gordon A.; Byrne, Chris; Halcox, Julian; Datta, D.; Capps, Nigel; Shoulders, Carol C.; Qureshi, Nadeem; Rees, Alan; Main, Linda; Cramb, Robert; Viljoen, Adie; Payne, Jules; Soran, Handrean

doi:10.1016/j.atherosclerosis.2019.10.011

Cited by 174 publications

(176 citation statements)

References 93 publications

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“…There are currently six national/international guidelines or consensus statements in place to recommend Lp(a) testing/therapy, including the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) [22], the American Society For Apheresis [32], the American Society for American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [33], the Canadian Cardiovascular Society guidelines [34], the National Lipid Association guidelines and the HEART UK consensus statement on Lipoprotein(a) [35], summarized in Table 1. Although differences among guidelines exist, in general, increased risk is suggested to occur at > The justification for this was to identify subjects at significantly increased cardiovascular risk based on Lp(a) elevation.…”

Section: Guideline Recommendations For Lp(a) Testingmentioning

confidence: 99%

“…HEART UK consensus statement Cegla et al [35] year prospective follow-up [44,45] respectively, have specifically addressed the question of reclassification of intermediate risk patients by measuring Lp(a). Both studies showed that a substantial proportion of individuals (15-40%) will be reclassified to either lower of higher risk categories depending on Lp(a) levels ( Fig.…”

Section: Therapeutic Considerations In Patients With Lp(a) Elevationmentioning

confidence: 99%

See 1 more Smart Citation

The dedicated “Lp(a) clinic”: A concept whose time has arrived?

Tsimikas

Stroes

2020

Atherosclerosis

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Section: Guideline Recommendations For Lp(a) Testingmentioning

confidence: 99%

Section: Therapeutic Considerations In Patients With Lp(a) Elevationmentioning

confidence: 99%

The dedicated “Lp(a) clinic”: A concept whose time has arrived?

Tsimikas

Stroes

2020

Atherosclerosis

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“…Individuals with FH have higher levels of serum Lp(a) compared with their non-affected relatives and an independent association with the type of mutation has been described. 55,57 Moreover, Lp(a) is a strong predictor for CAD in FH patients independent of other cardiovascular risk factors and it is recommended to measure Lp(a) once in those individuals with FH. 57 Effectiveness of cascade screening for high Lp(a) levels alone has not been assessed and established.…”

Section: Cardiovascular Risk Assessment In Fhmentioning

confidence: 99%

“…55,57 Moreover, Lp(a) is a strong predictor for CAD in FH patients independent of other cardiovascular risk factors and it is recommended to measure Lp(a) once in those individuals with FH. 57 Effectiveness of cascade screening for high Lp(a) levels alone has not been assessed and established. However, Lp(a) is an heritable risk factor transmitted in a dominant manner, and the testing of relatives of a patient with very high Lp(a) levels may be useful.…”

Section: Cardiovascular Risk Assessment In Fhmentioning

confidence: 99%

<p>Barriers to Early Diagnosis and Treatment of Familial Hypercholesterolemia: Current Perspectives on Improving Patient Care</p>

Alonso¹,

Isla²,

Muñiz-Grijalvo³

et al. 2020

VHRM

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Familial hypercholesterolemia (FH) is a frequent disorder associated with premature atherosclerotic cardiovascular disease. Different clinical diagnosis criteria are available, and cost of genetic testing has been reduced in the last years; however, most cases are not diagnosed worldwide. Patients with FH are at high cardiovascular risk and the risk can be reduced with lifelong lifestyle and pharmacological treatment. Statins and ezetimibe are available as generic drugs in most countries reducing the cost of treatment. However, the use of high-intensity statins combined with ezetimibe and PCSK9 inhibitors, if necessary, is low for different reasons that contribute to a high number of patients not reaching LDL-C targets according to guidelines. On the other hand, cardiovascular risk varies greatly in families with FH; therefore, risk stratification strategies including cardiovascular imaging is another element to consider for improving care and management of FH. There are numerous barriers depending on the awareness, knowledge, perception of risk, management and care of patients living with FH that impact in the diagnosis and treatment of the disorder. In this contemporary review, we analyze different barriers in the diagnosis and care of patients to improve patients' care and prevention of atherosclerotic cardiovascular disease and describe recent advances and strategies to improve the gaps in the care of FH, including global collaboration and advocacy.

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“…The newly released HEART-UK consensus statement on Lp(a) also supports the measurement of Lp(a) levels in patients with a personal or family history of premature ASCVD, those with FH or genetic dyslipidaemia (familial combined hypercholesterolaemia) or CAVD, as well patients with a first degree relatives who have raised Lp(a) (>200 nmol/L). The statement suggests the cardiovascular risk conferred by Lp(a) is determined by its serum concentration, with 32-90 nmol/L equivalent to minor risk, 90-200 nmol/L equivalent to moderate risk, 200-400 nmol/L equivalent to high risk, and with >400 nmol/L equivalent to very high risk [107] (Table 1).…”

Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Molecular, Population, and Clinical Aspects of Lipoprotein(a): A Bridge Too Far?

Ward

Kostner

Sullivan

et al. 2019

JCM

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There is now significant evidence to support an independent causal role for lipoprotein(a) (Lp(a)) as a risk factor for atherosclerotic cardiovascular disease. Plasma Lp(a) concentrations are predominantly determined by genetic factors. However, research into Lp(a) has been hampered by incomplete understanding of its metabolism and proatherogeneic properties and by a lack of suitable animal models. Furthermore, a lack of standardized assays to measure Lp(a) and no universal consensus on optimal plasma levels remain significant obstacles. In addition, there are currently no approved specific therapies that target and lower elevated plasma Lp(a), although there are recent but limited clinical outcome data suggesting benefits of such reduction. Despite this, international guidelines now recognize elevated Lp(a) as a risk enhancing factor for risk reclassification. This review summarises the current literature on Lp(a), including its discovery and recognition as an atherosclerotic cardiovascular disease risk factor, attempts to standardise analytical measurement, interpopulation studies, and emerging therapies for lowering elevated Lp(a) levels.

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HEART UK consensus statement on Lipoprotein(a): A call to action

Cited by 174 publications

References 93 publications

The dedicated “Lp(a) clinic”: A concept whose time has arrived?

The dedicated “Lp(a) clinic”: A concept whose time has arrived?

<p>Barriers to Early Diagnosis and Treatment of Familial Hypercholesterolemia: Current Perspectives on Improving Patient Care</p>

Molecular, Population, and Clinical Aspects of Lipoprotein(a): A Bridge Too Far?

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