I am not convinced that universal lipoprotein(a) [Lp(a)] testing should be recommended for everyone.
First, universal screening ignores an important principle of Bayesian reasoning. In individuals with a low pretest probability of cardiovascular disease, an abnormal test result is less likely to provide clinically useful information and more likely to generate anxiety, additional testing, and uncertainty without changing management.
Second, we currently do not have a proven therapy specifically targeting Lp(a) that has demonstrated improved clinical outcomes. While emerging therapies can substantially lower Lp(a) levels, it has not yet been definitively established that lowering Lp(a) translates into reductions in coronary artery disease, aortic stenosis, or cardiovascular mortality.
Some argue that identifying an elevated Lp(a) should lead clinicians to pursue more aggressive lipid lowering. I would counter that lipid-lowering therapy should already be optimized in any patient whose overall cardiovascular risk warrants treatment. The decision to intensify risk-factor management should be driven primarily by the patient's global cardiovascular risk rather than by a single biomarker.
Others contend that an elevated Lp(a) may motivate patients to adopt healthier lifestyles. However, recommendations regarding diet, exercise, weight management, smoking cessation, and other lifestyle measures apply broadly to all patients, regardless of their Lp(a) level. It is not clear that measuring Lp(a) meaningfully improves adherence to these recommendations.
Therefore, before endorsing universal Lp(a) screening, I would like to see stronger evidence that identifying elevated levels leads to management changes that improve patient-centered outcomes.
Brawndo has what plants crave. And anyway, Dr A. I. Geepiti will replace us, so, the last one out turn the lights off.
Thanks for the shout out!
I am not convinced that universal lipoprotein(a) [Lp(a)] testing should be recommended for everyone.
First, universal screening ignores an important principle of Bayesian reasoning. In individuals with a low pretest probability of cardiovascular disease, an abnormal test result is less likely to provide clinically useful information and more likely to generate anxiety, additional testing, and uncertainty without changing management.
Second, we currently do not have a proven therapy specifically targeting Lp(a) that has demonstrated improved clinical outcomes. While emerging therapies can substantially lower Lp(a) levels, it has not yet been definitively established that lowering Lp(a) translates into reductions in coronary artery disease, aortic stenosis, or cardiovascular mortality.
Some argue that identifying an elevated Lp(a) should lead clinicians to pursue more aggressive lipid lowering. I would counter that lipid-lowering therapy should already be optimized in any patient whose overall cardiovascular risk warrants treatment. The decision to intensify risk-factor management should be driven primarily by the patient's global cardiovascular risk rather than by a single biomarker.
Others contend that an elevated Lp(a) may motivate patients to adopt healthier lifestyles. However, recommendations regarding diet, exercise, weight management, smoking cessation, and other lifestyle measures apply broadly to all patients, regardless of their Lp(a) level. It is not clear that measuring Lp(a) meaningfully improves adherence to these recommendations.
Therefore, before endorsing universal Lp(a) screening, I would like to see stronger evidence that identifying elevated levels leads to management changes that improve patient-centered outcomes.
I wonder how Pharma & Co are going to spin the results, because I would be very surprised if they don’t try to resuscitate this Lazarus…
If at first you don’t succeed, trial and trial again.