Lp(a) Update – Was Kardiologinnen und Kardiologen wissen sollten // Lp(a) Update – what cardiologists should know

Journal für Kardiologie - Austrian Journal of Cardiology 2026; 33 (5-6): 106-110

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Keywords: kardiovaskuläre Risikoevaluierung,  Lipoprotein(a),  Lp(a),  Richtlinie,  cardiovascular risk assessment,  Guideline

Lipoprotein(a) [Lp(a)] has evolved from a ‘nice-to-know’ marker into a clear, causal driver of ASCVD and aortic valve stenosis – and is now consistently incorporated into risk stratification in current European and North American guidelines. This article provides a concise explanation of why Lp(a) occupies a unique position among lipoproteins due to its genetic determination, extremely wide concentration range and dose-dependent increase in risk – and why rigid ‘threshold values’ tend to obscure rather than reflect the actual risk. Based on the 2022 EAS Consensus Statement and the 2025 ESC/EAS Focused Update, it is demonstrated how a single Lp(a) measurement in all adults (‘once in a lifetime’) refines the SCORE2-based risk assessment, changes risk categories and influences therapeutic decisions – particularly regarding the intensity of LDL-C reduction – in daily practice.
The article provides a practical guide to measurement units (mg/dl vs. nmol/l), the interpretation of elevated levels, the role of Lp(a) in typical clinical scenarios (primary prevention, premature events, aortic stenosis, residual risk), and outlines the current status of Lp(a)-targeted phase 3 therapies. This is rounded off by a flowchart on testing strategy, specific recommendations for managing high Lp(a) levels, and answers to ‘Frequently Asked Questions’, which help cardiologists make informed decisions – and provide patients with sound advice.