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Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

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Kronenberg, Florian, Mora, Samia, Stroes, Erik S G, Ference, Brian A, Arsenault, Benoit J, Berglund, Lars, Dweck, Marc R, Koschinsky, Marlys +14 more·2022·European Heart Journal
DOI 10.1093/eurheartj/ehac361PMC PMC9639807
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Abstract

This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do not support Lp(a) as a risk factor for venous thrombotic events and impaired fibrinolysis. Very low Lp(a) levels may associate with increased risk of diabetes mellitus meriting further study. Lp(a) has pro-inflammatory and pro-atherosclerotic properties, which may partly relate to the oxidized phospholipids carried by Lp(a). This panel recommends testing Lp(a) concentration at least once in adults; cascade testing has potential value in familial hypercholesterolaemia, or with family or personal history of (very) high Lp(a) or premature ASCVD. Without specific Lp(a)-lowering therapies, early intensive risk factor management is recommended, targeted according to global cardiovascular risk and Lp(a) level. Lipoprotein apheresis is an option for very high Lp(a) with progressive cardiovascular disease despite optimal management of risk factors. In conclusion, this statement reinforces evidence for Lp(a) as a causal risk factor for cardiovascular outcomes. Trials of specific Lp(a)-lowering treatments are critical to confirm clinical benefit for cardiovascular disease and aortic valve stenosis.

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  • Vallejo-Vaz et al. observed that RC values, in patients suffering from ischemic heart disease, were significantly correlated with the development of major adverse cardiovascular events (MACEs).

    “Vallejo-Vaz, A.J. et al. observed that RC values, in patients suffering from ischemic heart disease, were significantly correlated with the development of major adverse cardiovascular events (MACEs) [11].”

    From Residual Cardiovascular Risk: Role of Remnants Cholesterol, Monocyte/HDL Ratio and Lipoprotein Ratios on Personalized Cardiovascular Prevention (2024) · cites this paper as [11]

    The Secondary prevention section (page unavailable) links elevated lipoprotein(a), not RC, to major adverse cardiovascular events in patients with coronary artery disease. Searches for Vallejo-Vaz, remnant cholesterol, and RC values found no passage in our copy addressing the attributed finding. (LLM, conf=0.76)

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Authors
Kronenberg, F., Mora, S., Stroes, E. S. G., Ference, B. A., Arsenault, B. J., Berglund, L., Dweck, M. R., Koschinsky, M., Lambert, G., Mach, F., McNeal, C. J., Moriarty, P. M., Natarajan, P., Nordestgaard, B. G., Parhofer, K. G., Virani, S. S., von Eckardstein, A., Watts, G. F., Stock, J. K., Ray, K. K., Tokgözoğlu, L. S., & Catapano, A. L.
Affiliations
  • Innsbruck Medical University (AT)
  • Brigham and Women's Hospital (US)
  • Amsterdam University Medical Centers (NL)
  • University of Cambridge (GB)
  • Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, and Department of Medicine, Faculty of Medicine, Université Laval , Québec City, QC , Canada
  • University of California, Davis (US)
  • British Heart Foundation Centre for Cardiovascular Science (GB)
  • Western University (CA)
  • Inserm (FR)
  • University Hospital of Geneva (CH)
  • Baylor Scott & White Health (US)
  • University of Kansas Medical Center (US)
  • Broad Institute (US)
  • University of Copenhagen (DK)
  • LMU Klinikum (DE)
  • Michael E. DeBakey VA Medical Center (US)
  • Institute of Clinical Chemistry, University Hospital Zurich, University of Zurich , Zurich , Switzerland
  • The University of Western Australia (AU)
  • European Atherosclerosis Society (SE)
  • Imperial College London (GB)
  • Hacettepe University (TR)
  • University of Milan (IT)
Corresponding author
Kronenberg, Florian
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2022-08-18
Volume
43
Issue
39
Pages
3925-3946
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehac361
PMC
PMC9639807
OpenAlex
W4293462875
Cited by
1,449
References
19
Citations by year
2026: 436 · 2025: 397 · 2024: 351 · 2023: 229 · 2022: 35
FWCI
242.52
Type
journal article
Language
en
Open access
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  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by-nc)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • U.S. Department of Veterans Affairs
  • Amgen
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • Sanofi
  • Gilead Sciences
  • Boston Scientific Corporation
  • Regeneron Pharmaceuticals
  • Ionis Pharmaceuticals
  • Amarin Corporation
  • Quest Diagnostics
  • Kowa Company
  • Mylan
  • European Atherosclerosis Society
  • Amryt Pharma
  • Agence Nationale de la Recherche (ANR-20-CE14-0009)
  • Daiichi-Sankyo
  • Servier
  • World Heart Federation
  • Silence Therapeutics
  • Esperion Therapeutics
  • National Institutes of Health
  • Genentech
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords
lipoprotein(a), atherosclerotic cardiovascular disease, aortic stenosis, cardiovascular risk prediction, Lp(a) testing, cascade testing, familial hypercholesterolemia, Lp(a)-lowering therapy, lipoprotein apheresis, aortic valve calcification, oxidized phospholipids, inflammation, diabetes risk, venous thromboembolism, fibrinolysis
MeSH terms
Adult, Aortic Valve Stenosis, Calcinosis, Cardiovascular Diseases, Humans, Cholesterol, LDL, Risk Factors, Lipoprotein(a), Atherosclerosis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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