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Lipoprotein(a) and mortality-a high risk relationship

Reinhard Klingel1,2, Andreas Heibges3, Cordula Fassbender3

  • 1Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany. klingel@apheresis-research.org.

Clinical Research in Cardiology Supplements
|March 7, 2019
PubMed

Insights

High lipoprotein(a) (Lp(a)) levels are linked to atherosclerotic cardiovascular disease (ASCVD) risk. Further research is needed to confirm if reducing Lp(a) lowers cardiovascular mortality, especially alongside LDL-C lowering therapies.

Area of Science:

  • Cardiology
  • Genetics
  • Biochemistry

Background:

  • Lipoprotein(a) (Lp(a)) is an established, independent risk factor for atherosclerotic cardiovascular disease (ASCVD).
  • Elevated Lp(a) levels, or Lp(a)-hyperlipoproteinemia (Lp(a)-HLP), are associated with early or progressive ASCVD and familial predispositions.
  • The German guideline for lipoprotein apheresis in Lp(a)-HLP patients identifies high-risk individuals using Lp(a) thresholds and ASCVD progression despite LDL-C therapy.

Purpose of the Study:

  • To investigate the plausible link between Lp(a)-associated risk and increased cardiovascular mortality.
  • To address inconsistencies in existing studies regarding Lp(a) concentration and mortality.
  • To highlight the need for prospective evaluations on the impact of combined Lp(a) and LDL-C lowering therapies on mortality.

Main Methods:

  • Review of existing investigations on Lp(a) concentration and mortality.
  • Analysis of factors potentially influencing study outcomes, such as population genetic homogeneity and follow-up duration.
  • Consideration of the interplay between LDL-C levels, LDL-C lowering treatments, and Lp(a) risk.

Main Results:

  • A majority of studies demonstrate an association between Lp(a) concentration and total or cardiovascular mortality.
  • Inconsistency exists in study findings, lacking a clear trend to explain variations.
  • Lp(a) and LDL particles exhibit a mutual effect modification on ASCVD risk.

Conclusions:

  • Lp(a) concentration may significantly increase cardiovascular mortality, particularly in specific patient groups.
  • Genetic homogeneity, long-term follow-up, and patient selection are crucial for clarifying Lp(a)'s impact on ASCVD progression and mortality.
  • Prospective studies are essential to validate whether targeted Lp(a) reduction, in addition to LDL-C lowering, effectively reduces cardiovascular and total mortality.

Keywords:
AtherosclerosisCardiovascular diseaseLipoprotein (a)Mortality

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