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Considerations for routinely testing for high lipoprotein(a)

Nick S Nurmohamed1,2, Patrick M Moriarty3, Erik Sg Stroes1

  • 1Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, The Netherlands.

Current Opinion in Lipidology
|August 9, 2022
PubMed

Insights

Lipoprotein (a) [Lp(a)] is a key risk factor for cardiovascular disease. Measuring Lp(a) helps identify high-risk patients who may benefit from emerging Lp(a)-lowering therapies.

Area of Science:

  • Cardiovascular Medicine
  • Lipidology
  • Pharmacology

Background:

  • Lipoprotein (a) [Lp(a)] is a confirmed causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve disease.
  • Lp(a) levels show a linear association with ASCVD risk.
  • Standard low-density lipoprotein cholesterol (LDL-C) therapies have minimal impact on Lp(a) levels.

Approach:

  • This review examines the clinical significance and therapeutic implications of Lp(a) measurement.
  • It highlights the development of novel RNA-based therapies targeting Lp(a).
  • Discusses the role of Lp(a) as a principal residual risk factor in lipid-driven ASCVD.

Key Points:

  • Emerging RNA-based therapeutics, such as pelacarsen and olpasiran, demonstrate significant Lp(a) reductions (up to 90%).
  • Pelacarsen (antisense oligonucleotide) and olpasiran (small interfering RNA) are in late-stage clinical trials.
  • These therapies target LPA messenger RNA, offering a new avenue for ASCVD risk management.

Conclusions:

  • Routine Lp(a) measurement is recommended for all patients to identify individuals with very high levels.
  • Patients with elevated Lp(a) may benefit from future Lp(a)-lowering treatments.
  • Current management for high Lp(a) patients involves optimizing LDL-C reduction and addressing other ASCVD risk factors.
Abstract

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