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Lipoprotein(a) is an independent risk factor for cardiovascular disease and its use is recommended in national and international guidelines for cardiovascular disease risk stratification. We undertook a survey to understand the availability and application of lipoprotein(a) measurement across UK lipid clinics. Fifty-three out of an estimated 200 lipid clinics (27%) provided responses. Eighty-one percent of 53 clinics had access to lipoprotein(a) measurement. Twenty-seven clinics disclosed the number of lipoprotein(a) tests ordered annually with approximately half of the clinics (52%) requesting 0-250 tests per year. Sixty percent measured lipoprotein(a) once per patient and the leading indication was a personal or family history of premature history of cardiovascular disease in those <60 years old. Sixty-three percent of clinics that provided comments with lipoprotein(a) results graded cardiovascular risk as per the HEART UK consensus statement. Sixty percent of clinics performed family cascade testing on lipoprotein(a) results ≥200 nmol/L. Lipoprotein(a) was reported in nmol/L, mg/dL, or mg/L by 48%, 24%, and 28% of responding clinics, respectively. National effort is required to provide universal access to lipoprotein(a) measurement and to harmonise the clinical application of this data., Competing Interests: Declaration of competing interest JC and RDGN have received lecture honoraria, consultancy fees, and/or research funding from Novartis., (Copyright © 2024. Published by Elsevier Inc.)

Background and Aims: Elevated concentrations of Lipoprotein (a) [Lp(a)] is an inherited, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This study aims to investigate the clinical utility for patients, and the economic benefit to healthcare systems and society of measuring Lp(a) concentrations more widely today., Methods: We conducted a structured literature review to identify the economic and health benefits and costs of measuring the Lp(a) concentration, potential barriers hindering the uptake of the measure, and potential solutions to address them. These findings were then discussed in an advisory board attended by experts and patient organisations., Results: It was found that if Lp(a) concentration is measured more widely today, patients, healthcare system and society would experience clinical and economic benefits even before specific Lp(a) lowering pharmacological treatments become available. Furthermore, a wider uptake of the Lp(a) measurement would support the development of epidemiological data., Conclusions: For Lp(a) measurement to be more widely used, key barriers which are hindering its uptake need to be addressed. These include i) the perception that the measure may have limited clinical value, ii) lack of awareness on Lp(a), iii) lack of data on the CV benefit of reducing Lp(a), iv) technical and clinical guidelines barriers, and v) healthcare system barriers. Scientific communities and industry should collaborate to address technical challenges and deficiencies in clinical guidelines. However, policy intervention will be crucial for national ASCVD plans to acknowledge the importance of Lp(a)., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Lipoprotein(a), Lp(a), is a modified atherogenic low-density lipoprotein particle that contains apolipoprotein(a). Its levels are highly heritable and variable in the population. This consensus statement by HEART UK is based on the evidence that Lp(a) is an independent cardiovascular disease (CVD) risk factor, provides recommendations for its measurement in clinical practice and reviews current and emerging therapeutic strategies to reduce CVD risk. Ten statements summarise the most salient points for practitioners and patients with high Lp(a). HEART UK recommends that Lp(a) is measured in adults as follows: 1) those with a personal or family history of premature atherosclerotic CVD; 2) those with first-degree relatives who have Lp(a) levels >200 nmol/l; 3) patients with familial hypercholesterolemia; 4) patients with calcific aortic valve stenosis and 5) those with borderline (but <15%) 10-year risk of a cardiovascular event. The management of patients with raised Lp(a) levels should include: 1) reducing overall atherosclerotic risk; 2) controlling dyslipidemia with a desirable non-HDL-cholesterol level of <100 mg/dl (2.5 mmol/l) and 3) consideration of lipoprotein apheresis., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)