Thanks Drs for this awesome summary of the latest evidence for the role of Lp(a) in atherosclerotic cardiovascular disease. One thing I am asking myself is the correlation between high LDL particles and LP(a) or in other words is it likely to have high levels of LDL but normal levels of LP(a) and if so how strongly does this scenario (high LDL and low Lp(a)) correlate with ASCVD?
They should be viewed as separate entities, which is why they need their own measurements. Both relate to ASCVD risk.
As mentioned, approximately 20% of the population overall (with significant variation by race/ethnicity) have elevated Lp(a) levels, and this is separate from LDL-C levels, which confer risk on their own as well.
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Thank you Austin. Now the problem is how do I explain that to my primary care physician 
What tests would you recommend in addition to a standard lipid panel? Both Lp(a) (at least once) and ApoB? If so, what would you recommend suggesting a primary care physician read if not familiar with these tests? Does your recommendation change based on, for example, both parents having high cholesterol and one having had aortic valve stenosis?
The website http://www.lpaclinicalguidance.com/ gives a percentage chance of a heart attack or stroke. Is there a number or range of numbers that becomes concerning? How much of a change is significant? Blood pressure can vary widely during the day and a small change (e.g, 5-10 points) can lead to a 0.5% or more change in risk.
For most people, a standard lipid panel and a Lipoprotein(a) level provide the majority of information we’d want. An ApoB level can add more information in certain situations, most often in those with insulin resistance or in higher-risk individuals who are treated with lipid-lowering therapy to low targets, but is fine to check regardless.
This recommendation does not change based on that family history, I would still check these values. National Lipid Association guidelines/executive summaries on these topics can provide useful information for clinicians, as is the paper we discussed on the podcast.
Risk falls along a continuous spectrum, so any cutoff will be, to an extent, arbitrary.
We discussed how to properly measure and assess resting blood pressure in our articles and podcasts on that topic; using the average of multiple, properly-taken, resting measurements using a validated/calibrated device will provide the best information.
Thank you.