A Focused Update to the 2019 NLA Scientific Statement on Lipoprotein(a) in Clinical Practice

The headline of this focused update is a single, consequential word: everyone. The National Lipid Association now recommends measuring lipoprotein(a) at least once in all adults — a clear step up from the more selective stance of its 2019 statement.

The reasoning behind universal screening is sound. Lp(a) is genetically fixed, stable across life, and common enough that selective testing misses too many carriers; a one-time measurement is cheap relative to the risk it reveals. The update also sharpens the risk tiers — low below 75 nmol/L, intermediate from 75 to 125, high at 125 and above — and makes two clarifying corrections: it eliminates race-based definitions of normal, and it rejects the practice of “correcting” LDL cholesterol for the cholesterol carried within Lp(a). It notes the FDA approval of lipoprotein apheresis for select high-risk patients and provides context for the targeted Lp(a)-lowering drugs then in Phase 3 trials.

The familiar limitation persists, and the update is honest about it: there is still no approved medication proven to lower Lp(a) and reduce events. So for now, a high result drives aggressive control of every other risk factor rather than treatment of Lp(a) itself — though the pending trials may soon change that.

We rate the evidence strong. It is a timely, well-reasoned update that pushes Lp(a) testing toward the standard of care, on the principle that an inherited, lifelong, and otherwise invisible risk is exactly the kind worth identifying once and early.