SERBAN BALANESCU, VIOLETA BOJINCA, ANDRA BALANESCU, MIHAI BOJINCA LIPOPROTEIN (A) BIOLOGY AND THE ROLE IN CARDIOVASCULAR MEDICINE Lipoprotein (a) -Lp(a) - is an apoB-based plasma lipoprotein associated with major cardiovascular disease (CVD). Hepatocytes produce it with no clear physiological role. The liver also catabolizes it by means of the LDL receptor. Close structural resemblance with plasminogen may induce an unconfirmed increased risk for thrombosis, while growth factor-like activity may have pro-inflammatory effects. It promotes atherosclerosis and stimulates macrophages to transform to foam cells under the intima. There is a strong inherited -genetic influence on serum Lp(a) levels. Kringle IV type 2 single nucleotide polymorphisms and copy number variations are the major determinants of Lp(a) concentration and volume. Small molecular volume determined by apo(a) isoforms are the most pathogenic for CVD. Serum Lp(a) levels are remarkably constant with age. Multiple epidemiologic trials demonstrated a strong association between Lp(a) levels and cardiovascular disease, mainly coronary disease and ischemic stroke. No specific treatment to lower Lp(a) and consecutive reduction in CV risk is currently available. PCSK9 inhibitors and plasmapheresis have the most profound effect on Lp(a) serum concentration.