From LDL-C to lipoprotein(a) - those who fail to learn from history are doomed to repeat it

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality globally.
• Despite available therapies like statins, achieving low-density lipoprotein cholesterol (LDL-C) goals is suboptimal.
• Residual ASCVD risk persists even with LDL-C lowering, necessitating alternative strategies.

Purpose of the Study:

• To review lessons from suboptimal LDL-C therapy implementation.
• To inform future strategies for residual ASCVD risk reduction.
• To highlight the potential of novel therapies targeting lipoprotein (a) (Lp(a)).

Main Methods:

• Literature review of LDL-C therapy implementation.
• Analysis of factors contributing to residual ASCVD risk.
• Examination of emerging Lp(a)-lowering therapies and clinical trials.

Main Results:

• Suboptimal attainment of LDL-C goals impacts ASCVD risk management.
• Lipoprotein (a) (Lp(a)) is a key target for novel therapies.
• Ongoing trials are evaluating the efficacy of Lp(a)-lowering agents on ASCVD events.

Conclusions:

• Lessons from LDL-C therapy implementation are crucial for future residual risk strategies.
• Effective implementation of novel Lp(a) therapies could significantly reduce ASCVD events.
• Future research and clinical practice should focus on comprehensive ASCVD risk reduction beyond LDL-C.