This phase 2 study with alirocumab decreased LDL-c levels and was generally well tolerated in pediatric HeFH patients. Two dosing regimens were selected for further investigation in a phase 3 trial.
Prof. Jukema explains the main principles for LDL-c-lowering therapy as described in the 2019 ESC/EAS guidelines and discusses results from several trials that investigated the effect of Lp(a) on CV outcomes.
Elevated Lp(a) contributes to pro-inflammatory gene expression of monocytes in both healthy subjects and CVD patients. Potent Lp(a)-lowering reduced the pro-inflammatory state of circulating monocytes.
Genetically determined elevated Lp(a) levels were inversely associated with high parental life span and health span (chronic disease–free survival), and higher measured Lp(a) levels were associated with all-cause and CV mortality.
Progression rate of aortic stenosis is predicted by high levels of ApoCIII-Lp(a) complexes in combination with high levels of Lp(a) or oxidized phospholipids.
Which lipids/lipoproteins, besides LDL-c, play a role in determining CV risk and can help targeting therapy in those with residual lipid risk?
Prof. Landmesser shows data that form the rationale behind new guideline recommendations, among which the lower LDL-c target for patients at very high risk.
Erin Bohula explains which determinants of residual CV risk we nowadays know and presents study results on how to target these.
Prof. Steg presents data of the ODYSSEY Outcomes trial in specific subgroups of ACS patients that benefit most from alirocumab therapy, and discusses the effect of this PCSK9 inhibitor by baseline Lp(a) levels.
In individuals of the Danish general population, high levels of Lp(a) as a consequence of low LPA KIV-2 number of repeats, were associated with high risk of mortality, in particular CV mortality.
ESC 2019 The guidelines emphasize that the absolute LDL-C reduction drives the clinical benefit. Evidence suggests a benefit of treating earlier, which may mean less intensive therapy in the longer-term.
Lp(a) meeting Prof. Marcovina emphasizes the importance of considering apo(a) size polymorphism when measuring Lp(a) levels in patients and discusses the Lp(a) Standardization Program.