Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction

Lipoprotein(a) is a global risk factor, but this expansive review — more than 200 references — argues it lands especially hard on some populations, South Asians in particular.

The authors assemble the genetic, epidemiologic, and Mendelian-randomization evidence establishing Lp(a) as an independent, inherited, causal driver of coronary disease and heart attack. The distinctive thread is ethnic variability: South Asians, who carry a disproportionate burden of cardiovascular disease, tend toward higher Lp(a) levels, as do people with familial hypercholesterolemia — making the marker a particularly important piece of their risk picture.

The practical takeaway is a now-familiar but still-underused recommendation: measure Lp(a) at least once in every patient, and weight it especially in high-risk ethnic groups and familial hypercholesterolemia. Even without an approved Lp(a)-lowering drug, the number sharpens risk and intensifies management of everything else.

We rate the evidence moderate-to-solid: a comprehensive synthesis including Mendelian-randomization data, though narrative rather than systematic, with no declared conflicts. Its clinical significance is high for the populations it spotlights — actionable for risk stratification and counseling today, and poised to matter more as targeted therapies arrive.