Elevated circulating concentrations of lipoprotein(a) [Lp(a)] is strongly associated with increased risk of atherosclerotic cardiovascular disease (CVD) and degenerative aortic stenosis. This relationship was first observed in prospective observational studies, and the causal relationship was confirmed in genetic studies. Everybody should have their Lp(a) concentration measured once in their lifetime. CVD risk is elevated when Lp(a) concentrations are high i.e. > 50 mg/dL (≥100 mmol/L). Extremely high Lp(a) levels >180 mg/dL (≥430 mmol/L) are associated with CVD risk similar to that conferred by familial hypercholesterolemia. Elevated Lp(a) level was previously treated with niacin, which exerts a potent Lp(a)-lowering effect. However, niacin is currently not recommended because, despite the improvement in lipid profile, no improvements on clinical outcomes have been observed. Furthermore, niacin use has been associated with severe adverse effects. Post hoc analyses of clinical trials with proprotein convertase subtilisin/kexin type-9 (PCSK9) inhibitors have shown that these drugs exert clinical benefits by lowering Lp(a), independent of their potent reduction of low-density lipoprotein cholesterol (LDL-C). It is not yet known whether PCSK9 inhibitors will be of clinical use in patients with elevated Lp(a). Apheresis is a very effective approach to Lp(a) reduction, which reduces CVD risk but is invasive and time-consuming and is thus reserved for patients with very high Lp(a) levels and progressive CVD. Studies are ongoing on the practical application of genetic approaches to therapy, including antisense oligonucleotides against apolipoprotein(a) and small interfering RNA (siRNA) technology, to reduce the synthesis of Lp(a).

脂蛋白 (a) [Lp(a)] 循环浓度升高与动脉粥样硬化性心血管疾病 (CVD) 和退行性主动脉瓣狭窄的风险增加密切相关。这种关系首先在前瞻性观察研究中观察到，因果关系在遗传研究中得到证实。每个人一生都应该测量一次 Lp(a) 浓度。当 Lp(a) 浓度高，即 > 50 mg/dL (≥100 mmol/L) 时，CVD 风险会升高。极高的 Lp(a) 水平 >180 mg/dL（≥430 mmol/L）与 CVD 风险相关，类似于家族性高胆固醇血症。升高的 Lp(a) 水平以前用烟酸处理过，烟酸具有有效的降低 Lp(a) 的作用。然而，目前不推荐使用烟酸，因为尽管血脂状况有所改善，没有观察到临床结果的改善。此外，烟酸的使用与严重的不良反应有关。对前蛋白转化酶枯草杆菌蛋白酶 / kexin 9 型 (PCSK9) 抑制剂临床试验的事后分析表明，这些药物通过降低 Lp(a) 发挥临床益处，而与它们有效降低低密度脂蛋白胆固醇 (LDL-C) 无关. 目前尚不清楚 PCSK9 抑制剂是否对 Lp(a) 升高的患者具有临床用途。血液分离术是一种非常有效的降低 Lp(a) 的方法，可降低 CVD 风险，但具有侵入性且耗时，因此仅适用于 Lp(a) 水平非常高和进行性 CVD 的患者。关于遗传方法在治疗中的实际应用的研究正在进行中，