Lp(a): Addressing a Target for Cardiovascular Disease Prevention

Nestor Vasquez, Parag Joshi

Research output: Contribution to journalReview article

Abstract

Purpose of Review: To review the current recommendations for lipoprotein(a) (Lp(a)) screening, the evidence behind the thresholds for increased cardiovascular disease (CVD) risk, and the available data supporting Lp(a) lowering. Recent Findings: Lp(a) is almost entirely genetically determined and has an independent causal association with CVD. Measurement of Lp(a) is challenging given the structural heterogeneity of apolipoprotein a (apo(a)), for which isoform-insensitive immunoassays should be used. Current guidelines do not recommend treatment to lower Lp(a) but rather focus on intensified preventive measures including low-density lipoprotein cholesterol (LDL-C) lowering in patients with high Lp(a). Evidence suggests that levels higher than 50 mg/dL (125 nmol/L) identify significantly increased CVD risk. Mendelian randomization studies suggest that in order to have a clinically significant reduction in coronary heart disease, Lp(a) levels should be reduced by at least 60–70 mg/dL to attain a significant benefit. Ongoing studies of targeted therapy with antisense oligonucleotides (ASO) have shown promising reductions in Lp(a) up to 80%, but a cardiovascular outcomes trial is needed. Summary: There is unquestionably an increased risk for CVD in patients with elevated Lp(a); however, measurement assay issues and the lack of Lp(a)-targeted therapies with proven outcome reduction limit the clinical utility of this important risk factor. Available evidence suggesting specific thresholds for clinically significant CVD risk are based on European or Caucasian populations, not accounting for important racial differences. Novel Lp(a)-targeted emerging therapies may need to account for an expected reduction of at least 60–70 mg/dL to achieve a clinically significant benefit.

Original languageEnglish (US)
Article number102
JournalCurrent Cardiology Reports
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Lipoprotein(a)
Cardiovascular Diseases
Apolipoproteins
Antisense Oligonucleotides
Therapeutics
Random Allocation
Immunoassay
LDL Cholesterol
Coronary Disease
Protein Isoforms
Guidelines

Keywords

  • Cardiovascular disease
  • Lipids
  • Lipoprotein(a)
  • Prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lp(a) : Addressing a Target for Cardiovascular Disease Prevention. / Vasquez, Nestor; Joshi, Parag.

In: Current Cardiology Reports, Vol. 21, No. 9, 102, 01.09.2019.

Research output: Contribution to journalReview article

@article{ebcac6c459d64893829da1e5c511549e,
title = "Lp(a): Addressing a Target for Cardiovascular Disease Prevention",
abstract = "Purpose of Review: To review the current recommendations for lipoprotein(a) (Lp(a)) screening, the evidence behind the thresholds for increased cardiovascular disease (CVD) risk, and the available data supporting Lp(a) lowering. Recent Findings: Lp(a) is almost entirely genetically determined and has an independent causal association with CVD. Measurement of Lp(a) is challenging given the structural heterogeneity of apolipoprotein a (apo(a)), for which isoform-insensitive immunoassays should be used. Current guidelines do not recommend treatment to lower Lp(a) but rather focus on intensified preventive measures including low-density lipoprotein cholesterol (LDL-C) lowering in patients with high Lp(a). Evidence suggests that levels higher than 50 mg/dL (125 nmol/L) identify significantly increased CVD risk. Mendelian randomization studies suggest that in order to have a clinically significant reduction in coronary heart disease, Lp(a) levels should be reduced by at least 60–70 mg/dL to attain a significant benefit. Ongoing studies of targeted therapy with antisense oligonucleotides (ASO) have shown promising reductions in Lp(a) up to 80{\%}, but a cardiovascular outcomes trial is needed. Summary: There is unquestionably an increased risk for CVD in patients with elevated Lp(a); however, measurement assay issues and the lack of Lp(a)-targeted therapies with proven outcome reduction limit the clinical utility of this important risk factor. Available evidence suggesting specific thresholds for clinically significant CVD risk are based on European or Caucasian populations, not accounting for important racial differences. Novel Lp(a)-targeted emerging therapies may need to account for an expected reduction of at least 60–70 mg/dL to achieve a clinically significant benefit.",
keywords = "Cardiovascular disease, Lipids, Lipoprotein(a), Prevention",
author = "Nestor Vasquez and Parag Joshi",
year = "2019",
month = "9",
day = "1",
doi = "10.1007/s11886-019-1182-0",
language = "English (US)",
volume = "21",
journal = "Current Cardiology Reports",
issn = "1523-3782",
publisher = "Current Medicine Group",
number = "9",

}

TY - JOUR

T1 - Lp(a)

T2 - Addressing a Target for Cardiovascular Disease Prevention

AU - Vasquez, Nestor

AU - Joshi, Parag

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Purpose of Review: To review the current recommendations for lipoprotein(a) (Lp(a)) screening, the evidence behind the thresholds for increased cardiovascular disease (CVD) risk, and the available data supporting Lp(a) lowering. Recent Findings: Lp(a) is almost entirely genetically determined and has an independent causal association with CVD. Measurement of Lp(a) is challenging given the structural heterogeneity of apolipoprotein a (apo(a)), for which isoform-insensitive immunoassays should be used. Current guidelines do not recommend treatment to lower Lp(a) but rather focus on intensified preventive measures including low-density lipoprotein cholesterol (LDL-C) lowering in patients with high Lp(a). Evidence suggests that levels higher than 50 mg/dL (125 nmol/L) identify significantly increased CVD risk. Mendelian randomization studies suggest that in order to have a clinically significant reduction in coronary heart disease, Lp(a) levels should be reduced by at least 60–70 mg/dL to attain a significant benefit. Ongoing studies of targeted therapy with antisense oligonucleotides (ASO) have shown promising reductions in Lp(a) up to 80%, but a cardiovascular outcomes trial is needed. Summary: There is unquestionably an increased risk for CVD in patients with elevated Lp(a); however, measurement assay issues and the lack of Lp(a)-targeted therapies with proven outcome reduction limit the clinical utility of this important risk factor. Available evidence suggesting specific thresholds for clinically significant CVD risk are based on European or Caucasian populations, not accounting for important racial differences. Novel Lp(a)-targeted emerging therapies may need to account for an expected reduction of at least 60–70 mg/dL to achieve a clinically significant benefit.

AB - Purpose of Review: To review the current recommendations for lipoprotein(a) (Lp(a)) screening, the evidence behind the thresholds for increased cardiovascular disease (CVD) risk, and the available data supporting Lp(a) lowering. Recent Findings: Lp(a) is almost entirely genetically determined and has an independent causal association with CVD. Measurement of Lp(a) is challenging given the structural heterogeneity of apolipoprotein a (apo(a)), for which isoform-insensitive immunoassays should be used. Current guidelines do not recommend treatment to lower Lp(a) but rather focus on intensified preventive measures including low-density lipoprotein cholesterol (LDL-C) lowering in patients with high Lp(a). Evidence suggests that levels higher than 50 mg/dL (125 nmol/L) identify significantly increased CVD risk. Mendelian randomization studies suggest that in order to have a clinically significant reduction in coronary heart disease, Lp(a) levels should be reduced by at least 60–70 mg/dL to attain a significant benefit. Ongoing studies of targeted therapy with antisense oligonucleotides (ASO) have shown promising reductions in Lp(a) up to 80%, but a cardiovascular outcomes trial is needed. Summary: There is unquestionably an increased risk for CVD in patients with elevated Lp(a); however, measurement assay issues and the lack of Lp(a)-targeted therapies with proven outcome reduction limit the clinical utility of this important risk factor. Available evidence suggesting specific thresholds for clinically significant CVD risk are based on European or Caucasian populations, not accounting for important racial differences. Novel Lp(a)-targeted emerging therapies may need to account for an expected reduction of at least 60–70 mg/dL to achieve a clinically significant benefit.

KW - Cardiovascular disease

KW - Lipids

KW - Lipoprotein(a)

KW - Prevention

UR - http://www.scopus.com/inward/record.url?scp=85069904436&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069904436&partnerID=8YFLogxK

U2 - 10.1007/s11886-019-1182-0

DO - 10.1007/s11886-019-1182-0

M3 - Review article

C2 - 31367887

AN - SCOPUS:85069904436

VL - 21

JO - Current Cardiology Reports

JF - Current Cardiology Reports

SN - 1523-3782

IS - 9

M1 - 102

ER -