**9. How and when should Lp(a) be measured**

Actually, Lp(a) is not measured routinely in clinical laboratories because of the following reasons: (i) there exists no effective treatment regime to lower plasma Lp(a); (ii) the currently available Lp(a) assays are not standardized and results from different laboratories vary considerably (see ref. [16]).


genetic component in Lp(a) plasma levels, Lp(a) should also be measured in all relatives of such index patients mentioned above. In addition, we advise that Lp(a) should be measured in the plasma of all premature myocardial infarction and stroke patients in addition to patients with borderline CHD risk because elevated Lp(a) puts them into a higher risk group. Since a specific practicable Lp(a) therapy is currently lacking, patients at increased CHD risk that exhibit elevated Lp(a) must be treated quite more rigorously with conventional lipid-lowering therapy than similar patients with low Lp(a). The monitoring of Lp(a), in addition, is advised in patients that undergo state-of-the-art therapy but still show a progression of atherosclerosis or vascular diseases, in all FH patients and in patients with genetic lipoprotein disorders, in patients with low HDL or high homocysteine, or in patients with disorders of hemostasis or fibrinolysis. Finally, we recommend assaying Lp(a) in patients with diabetes mellitus and autoimmune diseases.

In a consensus report of the European Atherosclerosis Society, monitoring of plasma Lp(a) is recommended in patients at a 10-year atherosclerosis risk of >3%. Particular attention should be paid to hemodialysis patients and patients with any form of kidney disease. In kidney disease, it is important before targeting hyperlipoproteinemias by medication to treat the primary disease as well as possible and to concentrate on modifiable CHD risk factors such as LDL-C, high blood pressure, smoking, blood glucose and obesity. Apheresis in addition to nicotinic acid therapy must be considered in these patients if feasible, although evidence-based results are still lacking.
