What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?

I don’t think that using Lp(a) to guide treatment is quite ready for prime time yet. It’s an independent predictor of risk compared to the rest of the lipid panel, but as far as I am aware, we do not yet have data that treating people based on it makes a difference.

What I may do in this scenario is...

A very common scenario of faith in both patients and doctors. I agree with the concept of “as low as reasonably achievable,” and that is how I would manage these patients at higher-than-average risk of coronary disease.

While there is no clear guidance to answer this question, a patient meeting this profile should be considered high risk. I would first start by calculating the 10-year ASCVD risk, which will depend on the patient's classic ASCVD risk profile (age, sex, race, cholesterol, HDL, BP, and HTN, Diabetes, ...

Well, trying not to disclose too much personal information, I do have quite an elevated lipoprotein(a), as do some of my family members. I also want to point out that it seems like female gender in and of itself is a risk factor. Another issue is that plaques resulting from elevated lipoprotein(a) a...

In nuclear cardiology, as in every other practice using radioisotopes, the principle of as low as reasonably achievable (ALARA) might also apply here in regard to cholesterol lowering. With combination therapies, LDL levels in the 30s are likely achievable for many people. These are opinions more th...

I agree with Dr. @Dr. First Last.

In the literature, we know well that Lp(a) increases ascvd risk, as do preDM and family history. Unfortunately, most of the risk calculators will not capture prediabetes (or the metabolic syndrome), and they do not include Lp(a).

Often, we are left with the clinical...

The downsides are costs and potential side effects. Individual patients may value not having side effects over some small absolute percentage of lowering the risk of adverse CV outcomes.