PURPOSE OF REVIEW:Lipoprotein (a) [Lp(a)] is highly suggested as an emerging risk factor in cardiovascular disease (CVD) prevention. However, there remains controversy regarding the shape of Lp(a) risk curve and the extent to which Lp(a) confers risk for CVD, independently of conventional lipid markers. This systematic review outlines the current state of knowledge regarding the role of Lp(a) in primary and secondary CVD prevention. RECENT FINDINGS:Searches resulted in the selection of n = 19 studies. In the context of primary CVD prevention, n = 9 cohorts, n = 2 case-cohorts, and n = 2 retrospective studies were identified, the majority of which suggested a significant positive association between Lp(a) and CVD onset. In terms of secondary CVD prevention, n = 5 cohorts and n = 1 case-cohort were considered as eligible highlighting from a positive to a neutral association between Lp(a) and CVD progression. SUMMARY:A positive association between Lp(a) and CVD seems to be supported by a large body of evidence yet it is comparatively moderate in magnitude and differentiates according to study population and the examined endpoints. This fact along with the lack of a definitive functional mechanism limits the potential connotation of Lp(a) in daily clinical practice.