Lipoprotein (a) in Cardiovascular Risk Assessment and Management in Diabetes Mellitus

Lipoprotein (a) [Lp(a)] is an independent and genetically-determined risk factor for coronary heart disease (CHD) and stroke that is not changed by alterations in lifestyle factors. It is now recommended by Canadian and other national lipid guidelines to be measured once in a person’s lifetime as part of overall assessment for cardiovascular risk, along with family history; presence of hypercholesterolemia; Type 2 diabetes (T2DM); hypertension; and smoking. The presence of elevated Lp(a) confers additional risk to the already high cardiovascular risk in individuals with T2DM. This review summarizes the nature and association of Lp(a) with elevated cardiovascular disease (CVD) risk; the increased cardiovascular risk in individuals with T2DM; potential therapies to lower Lp(a); whether or not to measure Lp(a); and recommendations on how to respond to the finding of elevated Lp(a) in a patient with T2DM.