Screening for High Lipoprotein(a)The Time Is Now

In 1994, the landmark 4S trial (Scandinavian Simvastatin Survival Study) reported that lowering low-density lipoprotein (LDL) cholesterol with simvastatin reduced cardiovascular events in patients with coronary artery disease and hypercholesterolemia.1 This seminal trial crystallized our understanding of the causal role of LDL cholesterol in atherosclerosis and launched the modern era of preventive cardiology. Today, the evidence in favor of LDL cholesterol as a modifiable causal driver of atherosclerosis has never been stronger, and current therapies, such as PCSK9 inhibitors (PCSK9i), can now lower LDL cholesterol to levels never previously seen. But despite achieving very low levels of LDL cholesterol, many patients continue to have recurrent events. Although the residual risk for cardiovascular events is likely multifactorial, in certain patients a key component is a high residual burden of atherogenic lipid particles attributable to high lipoprotein(a) [Lp(a)].