Systematic screening in relatives of probands with FH and elevated Lp(a) yielded more new cases than opportunistic testing in relatives of those without elevated Lp(a), but both approaches may be useful.

In a subanalysis of the FOURIER trial, treatment with evolocumab in patients with higher baseline Lp(a) resulted in non-significant greater percent reduction and greater absolute reduction of coronary events, compared to those with low baseline Lp(a).

In the ANITSCHKOW study, 16 weeks of treatment with evolocumab in patients with elevated Lp(a) levels, did not significantly alter arterial wall inflammation, despite lowering Lp(a) by 14%.

A retrospective review showed that children with FH and family history of early-onset ASCVD were more likely to have Lp(a) ≥50 mg/dL, compared with children with FH and family history of late-onset ASCVD.

Currently only small numbers of ASCVD patients achieve target LDL-c levels due to certain issues surrounding lipid lowering therapy. Prof. John Kastelein discusses the role of PCSK9 inhibition and future perspectives on lipid lowering.

A post-hoc analysis showed reduced LDL-c levels and improved lipid profiles up to 180 days with one or two doses of inclisiran on top of standard care in the presence and absence of diabetes, compared to placebo.

AHA 2018 In the ANITSCHKOW study, patients with very high Lp(a) were treated with evolocumab 420 mg once monthly. The 14% lowering in Lp(a) was not sufficient to eliminate the inflammatory stimulans induced by Lp(a).

AHA 2018 Lp(a) is a highly prevalent risk factor, with to date no therapy to lower its levels. A phase 2b study now shows that an antisense oligonucleotide potently lowers production of Lp(a), to optimal levels.

AHA 2018 A randomized phase 2b trial showed safety and efficacy of the antisense nucleotide AKCEA-APO(a)-Lrx at reducing Lp(a) levels in patients with CVD.

AHA 2018 The updated cholesterol guidelines help physicians to personalize treatment based on risk assessment, and now include CAC measurement to guide treatment decisions in certain patients.

Meta-analysis of individual-patient data shows that elevated Lp(a) levels of 50 mg/dL or higher were associated with an increased hazard ratio of CV events, independent of other risk factors and statin or placebo treatment.

This is a summary of the presentation by John Kastelein, in which he discusses targeting PCSK9 in clinical practice, focusing on issues surrounding prescription of PCSK9 monoclonal antibodies.