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Modern Approaches to Lower Lipoprotein(a) Concentrations and Consequences for Cardiovascular Diseases

Victoria A Korneva1, Tatjana Yurjevna Kuznetsova1, Ulrich Julius2

  • 1Department of Faculty Therapy, Petrozavodsk State University, Lenin Ave. 33, 185000 Petrozavodsk, Russia.

Biomedicines
|September 28, 2021
PubMed

Insights

Lipoprotein(a) (Lp(a)) is a cardiovascular risk factor. Current therapies offer limited Lp(a) reduction, but new treatments show promise for improving cardiovascular outcomes.

Area of Science:

  • Cardiology
  • Biochemistry

Background:

  • Lipoprotein(a) (Lp(a)) is a key determinant of cardiovascular risk, possessing pro-atherogenic, pro-thrombotic, pro-inflammatory, and pro-oxidative properties.
  • Standard lipid-lowering therapies are insufficient for reducing Lp(a) levels effectively.

Purpose of the Study:

  • To review current and emerging strategies for reducing Lipoprotein(a) levels and mitigating cardiovascular risk.
  • To highlight the limitations of traditional therapies and the potential of novel treatment modalities.

Main Methods:

  • Review of existing literature on Lp(a) and cardiovascular disease.
  • Analysis of data on PCSK9 inhibitors, inclisiran, lipoprotein apheresis, and novel Lp(a) synthesis inhibitors (antisense oligonucleotides, siRNA).

Main Results:

  • PCSK9 inhibitors show a modest Lp(a) reduction associated with improved cardiovascular outcomes, independent of LDL cholesterol.
  • Lipoprotein apheresis effectively lowers Lp(a) and improves prognosis in high-risk patients unresponsive to drug therapy.
  • New drugs targeting apolipoprotein(a) synthesis are under investigation.

Conclusions:

  • Effective reduction of Lp(a) is crucial for cardiovascular risk management.
  • Novel therapeutic strategies, including genetic silencing and apheresis, offer promising avenues for Lp(a) lowering.
  • Establishing target values for Lp(a) is essential for guiding treatment decisions.

Keywords:
cardiovascular riskinclisiraninhibitors of apolipoprotein(a) synthesislipoprotein apheresislipoprotein(a)proprotein convertase subtilisin/kexin type 9 inhibitors

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