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Despite robust evidence from epidemiological and genetic studies, Lp(a) remains underrecognised in clinical practice due to challenges in measurement, lack of guideline familiarity and limited therapeutic options. In this narrative review, we summarise the pathophysiological mechanisms linking Lp(a) to atherogenesis, thrombosis and inflammation, emphasising its unique structural features and causal role in cardiovascular disease. We discuss assay methodologies and make the case for a single lifetime measurement given the genetic stability of Lp(a). We review guideline\u2010based indications for testing, highlighting high\u2010risk populations such as those with premature ASCVD, a family history of cardiovascular disease and individuals of African or South Asian ancestry. We additionally outline clinical strategies to reduce ASCVD risk in individuals with elevated Lp(a), including lifestyle optimisation, statin therapy, PCSK9 inhibitors, and aspirin in select populations. Emerging targeted therapies, including antisense oligonucleotides and siRNA\u2010based agents, demonstrate up to 90% Lp(a) reduction and are currently being evaluated in large\u2010scale cardiovascular outcomes trials. As precision medicine advances, Lp(a) represents both a critical risk factor and a promising therapeutic target. Broader implementation of Lp(a) testing, particularly in high\u2010risk individuals, will help improve ASCVD prevention efforts.<\/jats:p>","DOI":"10.1111\/dom.16469","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T02:19:52Z","timestamp":1748485192000},"page":"34-46","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Why, how and in whom should we measure levels of lipoprotein(a): A review of the latest evidence and clinical implications"],"prefix":"10.1111","volume":"27","author":[{"given":"Alexander C.","family":"Razavi","sequence":"first","affiliation":[{"name":"Emory Clinical Cardiovascular Research Institute Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harpreet S.","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of California San 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