Lipoprotein(a): An independent, genetic, and causal factor for cardiovascular disease and acute myocardial infarction

Indian Heart J. 2019 Mar-Apr;71(2):99-112. doi: 10.1016/j.ihj.2019.03.004. Epub 2019 Mar 20.


Lipoprotein(a) [Lp(a)] is a circulating lipoprotein, and its level is largely determined by variation in the Lp(a) gene (LPA) locus encoding apo(a). Genetic variation in the LPA gene that increases Lp(a) level also increases coronary artery disease (CAD) risk, suggesting that Lp(a) is a causal factor for CAD risk. Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), a proatherogenic and proinflammatory biomarker. Lp(a) adversely affects endothelial function, inflammation, oxidative stress, fibrinolysis, and plaque stability, leading to accelerated atherothrombosis and premature CAD. The INTER-HEART Study has established the usefulness of Lp(a) in assessing the risk of acute myocardial infarction in ethnically diverse populations with South Asians having the highest risk and population attributable risk. The 2018 Cholesterol Clinical Practice Guideline have recognized elevated Lp(a) as an atherosclerotic cardiovascular disease risk enhancer for initiating or intensifying statin therapy.

Keywords: Acute myocardial infarction; Cardiovascular disease; Genetic risk factor; Genome-wide association studies; Indians; Isoforms; Kringles; Lipoprotein(a); Mendelian randomization; Oxidized phospholipids; Premature coronary artery disease; Single nucleotide polymorphism; meta-analysis.

Publication types

  • Review

MeSH terms

  • Asia, Southeastern
  • Cardiovascular Diseases / genetics*
  • Genome-Wide Association Study
  • Humans
  • Lipoprotein(a) / genetics*
  • Myocardial Infarction / genetics
  • Polymorphism, Single Nucleotide
  • Risk Factors


  • Lipoprotein(a)