Lipoprotein(a) in Atherosclerotic Cardiovascular Disease and Aortic Stenosis — EAS Consensus Statement

Twelve years after the European Atherosclerosis Society first put lipoprotein(a) on the map, this 2022 consensus statement returns to it with a far larger body of evidence — and a more confident, more practical set of instructions.

The update does three things. It hardens the science: new genetic, epidemiologic, and mechanistic data confirm Lp(a) as a causal driver not only of atherosclerotic disease but of calcific aortic valve stenosis, a connection the earlier statement could only suspect. It translates risk into numbers a clinician can use, offering a way to fold an Lp(a) level into a patient’s overall cardiovascular risk estimate rather than leaving it as an isolated curiosity. And it gives concrete clinical guidance on whom to test and how to manage those found to have high levels — primarily by intensifying control of every other modifiable risk factor.

The unavoidable limitation, shared by every Lp(a) document of its era, is the therapeutic gap. The statement was written while the drugs designed to lower Lp(a) directly were still in trials, so its management advice is necessarily about lowering surrounding risk rather than treating the molecule itself.

We rate the evidence strong. Dense with citations and authored by many of the field’s leading investigators, it is one of the most authoritative European statements on Lp(a) — and a clear marker of how far the case had advanced from association toward actionable, causal risk.