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CPE-007 · Risk modifiers
CV-06: Lipoprotein(a)
Lipoprotein(a). Evaluates Lp(a) ≥ 50 mg/dL (≥ 125 nmol/L).
Condition
- Lp(a) ≥ 50 mg/dL (≥ 125 nmol/L)
- OR Lp(a) never measured
What it reports
- Elevated Lp(a) is a risk enhancer
- One-time Lp(a) measurement is recommended by several societies
Diagnostic boundary
- Lp(a) is largely genetically determined; the value does not change with statins.
Evidence
- EV-ACCAHA-CHOL-2018Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. Circulation. 2019;139(25):e1082-e1143.Supports: Risk categories, risk enhancers, statin benefit groups and the coronary-calcium decision aid Very-high-risk ASCVD definition
- EV-ESC-EAS-2019Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2020;41(1):111-188.Supports: At least one lifetime measurement of Lp(a)
Cases where this rule fires
Open a case to see this rule fire with real inputs, then change the values until it stops.
CVR-FX-01
Prior myocardial infarction, LDL-C 88 on a statin
Secondary prevention, not very high risk.
CVR-FX-02
Very high risk with LDL-C 62 on maximal therapy
Two events: the threshold is 55.
CVR-FX-03
LDL-C 205 and tendon xanthomas
Severe hypercholesterolemia.
CVR-FX-04
Diabetes at 58 with LDL-C 110
A guideline statin group.
CVR-FX-05
Intermediate risk 12% with enhancers
Family history and an hs-CRP of 3.4.
CVR-FX-10
Lp(a) 180 nmol/L
An elevated Lp(a) in intermediate risk.
CVR-FX-11
Lp(a) never measured, family history of premature ASCVD
A one-time measurement prompt.
CVR-FX-12
apoB 138 with LDL-C 115
Particle burden above what LDL-C suggests.
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