Cardiology Letters 2025, 34(4):227-234

The role of lipoprotein (a) in the pathogenesis of cardiovascular diseases

Miriam Kozárová¹, Ján Tokarčík¹, Marcela Valiková-Bavoľárová², Zuzana Kozelová¹, Ladislav Tomčo³

¹ IV. interná klinika UPJŠ LF a UNLP, Košice

² Klinika pracovného lekárstva a klinickej toxikológie UPJŠ LF a UNLP, Košice

Lipoprotein (a) [Lp(a)] is the lipoprotein under the strongest genetic control. The main determinants of Lp(a) levels are the kringle-IV type 2 (KIV-2) repeat polymorphism (rs10455872 and rs3798220) and two common splice site variants in KIV-2 (4925G>A and 4733G>A) in gene LPA. Lipoprotein(a) plays an independent role in the development of cardiovascular (CV) and cerebrovascular diseases. This is supported by data from Mendelian randomization studies with clear evidence that high levels of Lp(a) increase CV risk even at low LDL cholesterol (LDL-C) levels and by that Lp(a) becomes a very active participant in atherogenesis and aortic stenosis progression. The recommendation to test Lp(a) at least once in a lifetime supported by international expert partners, ESC/EAS included and the Brussels Declaration signed on 24th March 2025 brings a new perspective on the prevention and stratification of CV risk. The hope for the 1.5 billion patients in the world with high Lp(a) is the arrival of innovative Lp(a) lowering therapies.

Keywords: lipoprotein(a); risk factor; atherosclerosis; aortic stenosis; coronary heart disease

Published: April 1, 2025  Show citation