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Updated: Sep 22, 2025

Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
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Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation

Published on: January 28, 2021

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Existing and emerging strategies to lower Lipoprotein(a)

Gregory G Schwartz1, Christie M Ballantyne2

  • 1Rocky Mountain Regional VA Medical Center and University of Colorado School of Medicine, Aurora, CO, USA.

Atherosclerosis
|May 23, 2022
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] increases cardiovascular risk. While some treatments don't affect Lp(a), PCSK9 inhibitors and apheresis lower it, with new therapies showing potential for significant Lp(a) reduction.

Area of Science:

  • Cardiology
  • Biochemistry
  • Pharmacology

Background:

  • Elevated lipoprotein(a) [Lp(a)] is a significant, independent risk factor for cardiovascular disease.
  • Many common cardiovascular risk reduction therapies have minimal or no effect on Lp(a) levels.
  • Existing Lp(a)-lowering agents like niacin show limited cardiovascular benefits.

Purpose of the Study:

  • To review current therapeutic strategies for managing lipoprotein(a)] associated cardiovascular risk.
  • To evaluate the efficacy and impact of emerging therapies targeting Lp(a) reduction.
  • To discuss the clinical implications of substantial Lp(a) lowering.

Main Methods:

  • Review of existing clinical evidence and therapeutic guidelines.
  • Analysis of pharmacological mechanisms of action for various cardiovascular drugs.
  • Evaluation of outcomes from clinical trials involving Lp(a)-modulating agents.

Main Results:

  • Standard therapies (aspirin, statins, fibrates, ezetimibe) show little impact on Lp(a).
  • PCSK9 inhibitors and lipoprotein apheresis are effective in lowering Lp(a) and reducing cardiovascular risk.
  • Novel agents like antisense oligonucleotides and small interfering RNA offer potential for >70% Lp(a) reduction.

Conclusions:

  • Managing Lp(a)-associated cardiovascular risk presents a clinical challenge.
  • PCSK9 inhibitors demonstrate benefit linked to baseline Lp(a) and reduction magnitude.
  • Future outcomes trials are crucial to validate the clinical benefit of substantial Lp(a) lowering with new agents.

Keywords:
Antisense oligonucleotidesApheresisLipoprotein(a)PCSK9 inhibitorsSmall interfering RNA

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