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While remaining silent on the role of high sensitivity C-Reactive Protein (hsCRP),2) the European Atherosclerosis Society (EAS) has issued a new consensus statement endorsing routine measurement of lipoprotein(a) [Lp(a)] among patients at moderate to high risk of cardiovascular disease (1). The EAS took an even larger step in this consensus document and recommended prescription of niacin therapy (1–3 g) to lower Lp(a) concentrations to less than 50 mg/dL. This recommendation is exceptionally broad, because as many as 1 in 5 adults may have an LP(a) concentration that exceeds 50 mg/dL. Therefore, the EAS recommendations urging healthcare providers to screen for high concentrations of Lp(a) and advising treatment of high concentrations with niacin mark radical changes in policy.The role of Lp(a) as an independent biomarker of vascular risk has been investigated for more than 20 years. Problems with standardization and reporting of Lp(a) assays have persisted without resolution. Therefore, it is reasonable to inquire what new evidence has emerged to explain this seismic shift in thinking and to justify these new and far-reaching recommendations for screening and treatment in the field of cardiovascular disease prevention.Surprisingly, the impetus and rationale for these changes stem largely from recent observational studies using the techniques of mendelian randomization, which refers to the random assortment of gene variants passed from parents to offspring. Mendelian randomization is a method used by some epidemiologists in an attempt to understand causal pathways for intermediate phenotypes. With regard to Lp(a), results of 2 recently reported studies demonstrated that polymorphism in the lipoprotein, Lp(a) ( LPA ) gene is associated both with plasma Lp(a) concentrations and with subsequent vascular risk (2, 3). Proponents have suggested that these data define a causal relationship between Lp(a) and cardiovascular disease (4). However, the technique of mendelian randomization is itself highly controversial, and …

clinical chemistry

European Atherosclerosis Society Screening Recommendations for Lipoprotein(a) and High-Sensitivity C-Reactive Protein: Double Standard or Failure of Evidence-Based Medicine?