From the Research
Management of elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) levels should focus on reducing cardiovascular risk through lifestyle modifications and pharmacological interventions, with statin therapy as the cornerstone of treatment, as evidenced by the most recent study 1. The goal is to reduce Lp-PLA2 levels and overall cardiovascular risk. Key lifestyle modifications include:
- Adopting a Mediterranean or DASH diet low in saturated fats and refined carbohydrates
- Regular aerobic exercise (150 minutes weekly of moderate-intensity activity)
- Smoking cessation
- Weight management targeting a BMI below 25 Pharmacologically, the treatment plan may involve:
- High-intensity statins like atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily, which have been shown to be effective in reducing Lp-PLA2 levels 2, 3
- Addition of ezetimibe 10 mg daily for patients not achieving adequate response with statins alone, as it has been demonstrated to further reduce LDL-C, hsCRP, and Lp-PLA2 levels when combined with rosuvastatin 1
- Consideration of PCSK9 inhibitors (evolocumab 140 mg every 2 weeks or alirocumab 75-150 mg every 2 weeks) in cases of statin intolerance
- Omega-3 fatty acids (2-4 g daily) may provide additional benefit Treatment efficacy should be monitored through regular lipid panels and periodic Lp-PLA2 testing, typically at 3-6 month intervals after initiating therapy, as recommended by the consensus panel 4. It's worth noting that while Lp(a) is also a risk factor for cardiovascular disease, the management of elevated Lp-PLA2 levels is the primary focus, and Lp(a) measurement and treatment should be considered separately, as discussed in the recent review 5.