Background: Lipoprotein(a) [Lp(a)] is an atherogenic lipoprotein composed of an LDL-like particle and apolipoprotein(a) [apo(a)]. Plasma Lp(a) concentration is determined predominantly by genetic factors, particularly variation in the LPA gene, and remains relatively stable throughout life. Epidemiological, genetic and clinical evidence has identified Lp(a) as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis [1,2].

Aim: This review examines the role of Lp(a) in endocrinology, focusing on diabetes mellitus, obesity, thyroid disorders, polycystic ovary syndrome (PCOS), menopause and other endocrine disorders. It also discusses Lp(a) measurement, clinical interpretation, and current and emerging therapeutic strategies.

Materials and Methods: Publications indexed in PubMed and contemporary literature were reviewed, including ESC/EAS and National Lipid Association guidelines, systematic reviews, meta-analyses and clinical studies of emerging Lp(a)-targeted therapies. Particular attention was given to publications from 2020 to 2026.

Results: Elevated Lp(a) levels are consistently associated with coronary artery disease, myocardial infarction, ischemic stroke, peripheral arterial disease and aortic stenosis [1,2]. In endocrine practice, Lp(a) is particularly relevant in patients with diabetes, thyroid disorders or PCOS, and during the menopausal transition. Contemporary guidance recommends measuring Lp(a) at least once in adulthood [1,3]. Emerging antisense oligonucleotide and small interfering RNA (siRNA) therapies have produced substantial reductions in Lp(a), although their effects on cardiovascular events have yet to be established conclusively [4-7].

Conclusion: Lp(a) is an important contributor to cardiometabolic risk and connects lipidology, endocrinology and preventive cardiology. Incorporating Lp(a) measurement into risk assessment may improve the identification of patients with residual cardiovascular risk. Specific Lp(a)-lowering therapies may substantially change the management of these patients in the future.

Keywords: Lipoprotein(a); Lp(a); Apolipoprotein(a); Endocrinology; Diabetes Mellitus; Hypothyroidism; PCOS; Obesity; Menopause; Atherosclerosis

1. Mach F., et al. “2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias”. European Heart Journal 42 (2025): 4359-4378.
2. Tsimikas S., et al. “Lipoprotein(a): a clinical update”. Circulation 149 (2024): 132-148.
3. Koschinsky ML., et al. “A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice”. Journal of Clinical Lipidology 3 (2024): e308-e319.
4. Nicholls SJ., et al. “Olpasiran for the treatment of elevated lipoprotein(a)”. New England Journal of Medicine 387 (2022): 1855-1864.
5. Tsimikas S., et al. “Lipoprotein(a) reduction in persons with cardiovascular disease”. New England Journal of Medicine 3 (2020): 244-255.
6. Bittner VA., et al. “Lipoprotein(a)-lowering therapies in development: current evidence and future perspectives”. Current Atherosclerosis Reports (2025).
7. “Comparative effects of emerging Lp(a)-lowering agents and PCSK9-directed therapies on lipoprotein(a): a network meta-analysis of randomised clinical trials”. European Heart Journal (2026).
8. Olejarz M., et al. “Lipoprotein alterations in endocrine disorders—a review of the recent developments in the field”. Frontiers in Endocrinology (Lausanne) 15 (2024): 1354098.
9. “Exploring the effect of thyroid hormone on serum lipoprotein(a) levels in patients with thyroid hormone dysfunction: a systematic review”. Endocrine Regulations (2024).
10. Nordestgaard BG., et al. “Lipoprotein(a) and cardiovascular disease”. Lancet (2024).
11. Nambi V., et al. “Lipoprotein(a) and cardiovascular risk: clinical implications of an inherited risk factor”. Circulation (2024).
12. Tsimikas S., et al. “Emerging therapies for lowering lipoprotein(a)”. European Heart Journal (2024).
13. Koren MJ., et al. “Preclinical and clinical development of therapies targeting lipoprotein(a)”. Journal of Clinical Lipidology (2025).
14. “Lp(a)-lowering agents in development: A new era in tackling the burden of cardiovascular risk?” Current Atherosclerosis Reports (2025).
15. “Efficacy and safety of lipoprotein(a)-targeted therapeutics: a systematic review and network meta-analysis” (2026).