Lp(a) significance in ASCVD risk assessment
What advice would you have for 45 year Indian woman who has ASCVD risk score of 1% for next 10 years but has genetic marker Lp(a) of 140 nmol/L. LDL is 114, a1c is 6.3. Doctor is not concerned and advised reduce weight and control sugar. No medication required for now. Both parents don’t have history of heart disease but there in extended family How important is Lp(a) and why is not included in the ASCVD score ?
Risk prediction using ASCVD risk score is fraught with problems in South Asians because in the original studies not enough of us were represented. The person you describe is EXACTLY the kind of person we advise being aggressive from the preventive standpoint. The high Lp(a), LDL over 100, and pre-diabetes status all strongly predispose to cardiovascular disease. Personally, in addition to overall risk factor modification (wt, diet, exercise etc) I would start statin therapy with an aggressive goal to lower LDL to less than 70 at a minimum.