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Therapeutic lowering of lipoprotein(a): implications for improving outcomes in patients with peripheral arterial

Stephen J Nicholls1

  • 1From the Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia.

Current Opinion in Lipidology
|July 23, 2025
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] is linked to peripheral arterial disease (PAD) risk. New therapies targeting Lp(a) show promise for reducing cardiovascular events in PAD patients.

Area of Science:

  • Cardiovascular Medicine
  • Lipidology
  • Genetics

Background:

  • Elevated lipoprotein(a) [Lp(a)] is a significant risk factor for atherosclerotic cardiovascular disease.
  • Patients with peripheral arterial disease (PAD) often have high residual cardiovascular risk despite standard treatments.
  • Lp(a) independently associates with an increased risk of developing PAD.

Purpose of the Study:

  • To explore the therapeutic potential of targeting elevated lipoprotein(a) [Lp(a)] in patients with peripheral arterial disease (PAD).

Main Methods:

  • Review of cohort studies and emerging therapeutic strategies for Lp(a) management.
  • Evaluation of novel agents including RNA-targeted therapies and small molecule disrupters.
  • Assessment of ongoing cardiovascular outcomes trials for Lp(a) lowering agents.

Main Results:

  • Lp(a) plays a causal role in atherosclerotic cardiovascular disease and PAD development.
  • Current management for high Lp(a) includes risk factor optimization and aspirin.
  • New injectable RNA-targeted agents and small molecule disrupters effectively lower Lp(a) and are well-tolerated.

Conclusions:

  • Lp(a) is crucial in cardiovascular disease, including PAD.
  • The clinical benefit of intensive Lp(a) lowering requires further investigation.
  • Integrating Lp(a) testing and novel therapeutics may significantly improve outcomes for PAD patients.
Abstract

Keywords:
lipids and lipoproteinslipoprotein(a)peripheral arterial diseasepreventionrisk factors

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