EAS 2019 Prof. Chapman lists the newest findings on the associations of Lp(a) levels, PCSK9 inhibitors and CV risk, based on new analyses of the FOURIER and ODYSSEY OUTCOMES trials.

A meta-analysis showed significantly elevated Lp(a) levels with statin therapy and a cell culture study demonstrated increased apo(a) production after statin treatment, which possibly contributes to the residual CV risk in subjects on statins.

EAS 2019 By debating on whether high Lp(a) levels should be treated or not, Brian Ference and Sotirios Tsimikas critically reviewed the available evidence on the link between Lp(a) and CV risk. With poll

A mendelian randomization analysis in population-based cohorts assessed that lowering Lp(a) by 65.7 mg/dL yields a similar CHD event risk reduction as lowering LDL-c by 38.67 mg/dL

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.