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Lipoprotein(a) — EECC MCQ

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ModerateHypertension & Preventive CardiologyLipoprotein(a)EECC

A 50-year-old man has a 10-year SCORE2 cardiovascular risk of 8%. His LDL-C is 3.2 mmol/L on lifestyle measures alone. He has no established CVD, diabetes, or familial hypercholesterolaemia. His Lp(a) level is 180 nmol/L (>90th percentile). How does the elevated Lp(a) affect his risk classification?

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Correct answer: C — Elevated Lp(a) is a risk-enhancing factor that may reclassify him to a higher risk category, supporting more aggressive LDL-C lowering

Elevated lipoprotein(a) is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis. In UK practice, an Lp(a) level >90 nmol/L is considered raised; 180 nmol/L falls in the range associated with a moderate increase in cardiovascular risk. Standard risk calculators can underestimate risk because they do not fully incorporate Lp(a). Therefore, in a primary-prevention patient with borderline/intermediate estimated risk, raised Lp(a) acts as a risk-enhancing factor and may justify reclassification to a higher risk category, supporting more intensive management of modifiable risk factors, particularly LDL-C/non-HDL-C lowering. Lp(a) should not be ignored, is relevant to arterial disease rather than only venous thromboembolism, does not require established CVD to matter, and niacin is not recommended specifically to treat raised Lp(a).

Reference: HEART UK Medical, Scientific and Research Committee. HEART UK consensus statement on Lipoprotein(a): A call to action. Atherosclerosis. 2019;291:62-70. https://www.heartuk.org.uk/downloads/health-professionals/lp%28a%29-statement-of-care.pdf