Module 8: Lp(a) & ApoB
Lipoprotein(a) and Apolipoprotein B assessment and management.
Patient Context
Provide risk context for goal-directed interpretation
Lipoprotein(a) Assessment
Lipoprotein(a) is a genetically determined, independent risk factor for atherosclerotic cardiovascular disease
Table 4 tiers: <75 Reference, 75-124 Borderline, 125-249 Elevated, 250+ High/Very High/Extreme
Apolipoprotein B Assessment
Apolipoprotein B reflects atherogenic particle number and is a secondary treatment target
Should You Measure Lipoprotein(a) and Apolipoprotein B?
Guideline indications for when to obtain these measurements
Lipoprotein(a) Measurement
Class I, Level B-NR
- Lipoprotein(a) measurement is recommended at least once in all adults for atherosclerotic cardiovascular disease risk assessment (Class 1, Level B-NR). This is a universal recommendation — no special indication is required.
Assay Guidance
Use laboratories employing assays that are insensitive to apolipoprotein(a) [apo(a)] isoforms and traceable to official reference standard materials to more accurately measure Lipoprotein(a) and characterize atherosclerotic cardiovascular disease risk (Class 1, Level B-NR). Molar units (nmol/L) are preferred over mass units (mg/dL) due to variability in apo(a) isoform size. Source: Section 3.4, Recommendation 3.
Apolipoprotein B Measurement
Class IIb, Level B-NR
No specific indication identified based on the current patient context. Apolipoprotein B is most useful when triglycerides are 150-499 mg/dL, or in patients with diabetes or Cardiovascular-Kidney-Metabolic syndrome.
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