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J Clin Lipidol. 2016 Mar-Apr;10(2):215-24. doi: 10.1016/j.jacl.2016.02.012. Epub 2016 Mar 5.

JCL Roundtable: Should we treat elevations in Lp(a)?

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Emeritus College, Emory University School of Medicine, Atlanta, GA, USA. Electronic address:
Department of Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Lipoprotein Metabolism Section, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Division of Cardiovascular Diseases, Department of Medicine, UCSD Cardiology La Jolla, Perlman Ambulatory Center, La Jolla, CA, USA.


The focus of this Roundtable discussion is the mysterious lipoprotein Lp(a). There is growing evidence that it confers significant risk of vascular disease at high plasma concentrations. The concentration in plasma is highly variable from person to person but relatively stable in any given individual. The issue of defining this as a target of treatment has many facets, which have stymied clinicians in their management of this risk factor. The pertinent questions are many such as: "How does one obtain the most meaningful measure as there are so many components?" "What agents are truly effective in lowering this lipoprotein particle?" "Does direct treatment with reduction affect risk?" "How does low-density lipoprotein-cholesterol relate to the risk?" "If low-density lipoprotein-cholesterol is reduced, is there residual risk related directly to Lp(a)?" and "Are there effective therapies under development?" For this Roundtable, I am fortunate to have three experts that have studied these questions in various settings and have agreed to answer my questions relevant to these clinical issues. These include Dr Moriarty from the University of Kansas, Dr Remaley from the National Institutes of Health, and Dr Tsimikas from the University of California San Diego.


LDL-Cholesterol; Lipoprotein; Lp(a); Pharmacotherapy; Vascular disease

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