This comprehensive review delves into the evolving landscape of Lp(a) measurement standardsand examines the discordance and challenges in cardiovascular risk assessment in the contextof Lp(a). Acknowledging the shifting trends towards universal screening for Lp(a) endorsed by international societies working on risk assessment, management, and prevention of cardiovascular diseases, this review highlights the divergence in recommendations and the lackof consensus on Lp(a) risk thresholds. Ethnic variations in Lp(a) levels and ongoing clinical trial stargeting Lp(a) underscore the urgency of a unified and standardized approach to Lp(a) measurement. This article explores the intricacies of Lp(a) isoform size heterogeneity, availablemeasurement approaches, and the reporting unit challenge for the molecule. Emphasis is placed on collaborative efforts, transparent calibration, and the pivotal role of laboratories in ensuring the precision and reliability of Lp(a) measurements. The discussion encompasses thecall for unified calibration standards, highlighting the need for continuous external quality assessment and transparent reporting in clinical laboratories until a standardized Lp(a) measurement system is established.