The Impact of Current and Emerging Therapies on Lipoprotein(a)

Increasing evidence has implicated lipoprotein (a) (Lp(a)) in the causality of cardiovascular disease. While measuring Lp(a) has an established role in cardiovascular risk assessment and triaging patients for more intensive risk factor control, there is considerable interest in the ability of medical therapies to lower Lp(a) levels. While statins have been reported to increase Lp(a) levels, a number of existing lipid-lowering interventions have been reported to modestly lower Lp(a) levels, with evidence that this contributes to the reduction in cardiovascular risk observed with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. Lp(a) lowering has also been reported with emerging therapies via direct inhibition of apolipoprotein A (Apo A) synthesis or Lp(a) particle formation and indirectly in response to treatment with cholesteryl ester transfer protein (CETP) inhibitors. This article will review the effects of these therapies and implications for cardiovascular risk.