What is the role of Lp(a) in residual cardiovascular risk and management?

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Lp(a) is an independent contributor to cardiovascular risk that can drive residual risk even when LDL-C is at goal. It isn’t included in routine lipid panels, so Lp(a) levels require a separate, dedicated assay (often done once in adulthood, especially with a family history of early ASCVD). If Lp(a) is elevated, management focuses on lowering overall risk and, when appropriate, using therapies that can reduce Lp(a). PCSK9 inhibitors can modestly lower Lp(a) by about 20–30% in addition to lowering LDL-C, offering extra ASCVD risk reduction. Other Lp(a)-specific therapies are still being studied, so current practice centers on patients with high Lp(a) and elevated risk who may benefit from these agents. Lifestyle measures help overall risk but do not substantially lower Lp(a). In short, lipid panels do not fully capture Lp(a) levels, so assessing Lp(a) separately is important for guiding management.