From the Guidelines
The most effective treatment for elevated Lipoprotein(a) (Lp(a)) is the use of antisense therapy, which has been shown to lower plasma Lp(a) levels by up to 90% or more, as demonstrated in recent studies 1. This approach is particularly significant in managing Lp(a)-mediated risk of cardiovascular disease and aortic stenosis. The primary focus of treatment should be on reducing overall cardiovascular risk, and while traditional methods such as optimizing LDL cholesterol with high-intensity statins and lifestyle modifications are crucial, the introduction of antisense therapy offers a direct and highly effective means of lowering Lp(a) levels. Key considerations in the management of elevated Lp(a) include:
- Aggressive management of overall cardiovascular risk
- Use of antisense therapy to directly lower Lp(a) levels
- Optimization of LDL cholesterol with high-intensity statins such as atorvastatin or rosuvastatin
- Addition of ezetimibe or PCSK9 inhibitors for patients with persistently elevated LDL
- Lifestyle modifications including a heart-healthy diet, regular exercise, smoking cessation, and weight management
- Consideration of lipoprotein apheresis in very high-risk patients with severely elevated Lp(a) in specialized centers. It's essential to note that while several guidelines and studies discuss the management of dyslipidemias and the role of Lp(a) in cardiovascular disease 1, the most recent and highest quality evidence supports the use of antisense therapy as a groundbreaking approach in directly targeting and significantly reducing Lp(a) levels.
From the Research
Treatment Options for Elevated Lipoprotein(a) (Lp(a))
Elevated Lp(a) is a prevalent condition affecting over 20% of the population and is associated with an increased risk of cardiovascular disease 2. The best treatment options for elevated Lp(a) include:
- Lipoprotein apheresis (LA), which efficiently lowers Lp(a) and has been associated with a reduction in incident CV events 2
- Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), which can reduce Lp(a) levels by up to 30% [(2,3)]
- Antisense oligonucleotides (ASO), which have shown good safety and strong efficacy in reducing Lp(a) levels by up to 90% [(2,3)]
Management of Patients with Elevated Lp(a)
The management of patients with elevated Lp(a) involves:
- Aggressive management of traditional cardiovascular risk factors, including LDL-cholesterol (LDL-C) 4
- Consideration of aspirin in primary prevention and prolonged dual antiplatelet therapy in secondary prevention 4
- Use of Lp(a) as a risk enhancer to guide medical care and shared decision-making 4
Emerging Strategies for Lowering Lp(a)
Emerging strategies for lowering Lp(a) include:
- Antisense oligonucleotides and small interfering RNA agents targeting apolipoprotein(a), which have the potential to reduce circulating Lp(a) concentrations by more than 70% 3
- Ongoing cardiovascular outcomes trials, such as Lp(a)HORIZON, which will provide insight into the clinical benefit of lowering Lp(a) 2