LPA and metabolic syndrome: Indeed, the 2019 ESC guideline for the management of dyslipidemias give a class IIa/Level of evidence C recommendation for a “once in a lifetime” Lp(a) measurement, with a comparable CV risk-profile of patients with elevated Lp(a) (>180 mg/dl and >430 nmol/l, respectively) to patients with heterozygous familial hypercholesterolemia [3].