Lipoprotein(a) Levels in a Global Patient Population with Established ASCVD (Lp(a)HERITAGE)

The Lp(a)HERITAGE registry characterized Lp(a) levels in 48,135 patients with established ASCVD across 45 countries, providing the largest global dataset on Lp(a) distribution in a high-risk cardiovascular population.

Elevated Lp(a) (≥50 mg/dL) was present in approximately 26% of the global ASCVD population, with substantial geographic and racial variation. Among patients with premature cardiovascular events — MI or stroke before age 55 — the prevalence of elevated Lp(a) was even higher. Lp(a) levels correlated with recurrent event risk, supporting its role as an independent contributor to residual cardiovascular risk in patients already on guideline-directed therapy.

The registry documents the scale of the Lp(a) problem in established cardiovascular disease. If 26% of ASCVD patients have elevated Lp(a) — and no currently approved Lp(a)-lowering therapy exists in most markets — this represents a large unmet therapeutic need. The Lp(a)HERITAGE data provide the denominator for estimating the potential population benefit of emerging Lp(a)-specific therapies (siRNA, antisense oligonucleotides) now in late-stage trials.

For individual patients, Lp(a) measurement in the context of established or premature ASCVD is now standard in many guidelines — the HERITAGE registry data underline why.

We rate the evidence strong. A large, well-characterized global registry establishing the prevalence and clinical impact of elevated Lp(a) in ASCVD patients — essential context for evaluating emerging Lp(a)-targeted therapies.