Lipoprotein(a) and Atherosclerotic Cardiovascular Disease,the Impact of Available Lipid-Lowering Medications on Lipoprotein(a): An Update on New Therapies |
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| Affiliation: | 1. Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio;2. Department of Medicine, Diabetes & Obesity Center, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;1. The Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China;2. Department of Ultrasonography, Yuhang Third People’s Hospital, Hangzhou, China;3. Department of Ultrasonography, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China;1. Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas;2. Center for Health Data Science and Analytics, Houston Methodist Hospital Research Institute and Weill Cornell Medicine, Houston, Texas;1. Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey;2. Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;3. PROUD Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey;4. Division of Pediatric Endocrinology, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;1. Nursing Department, Universitat Rovira Virgili, Campus Terres de l’Ebre, Avenue Remolins, Tarragona, Spain;2. Department of Health and Medical Science, Liwa College of Technology, Abu Dhabi, United Arab Emirates;3. Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, Tarragona, Spain;1. Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA;2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA;3. Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN;4. Department of Medicine, University of California, Irvine, CA;5. Department of Medicine, Beth Israel Deaconess Medical Center, Brookline, MA;6. Division of Endocrinology, Kaiser Permanente of Georgia, and Department of Endocrinology, Emory University School of Medicine, Atlanta, GA |
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| Abstract: | ObjectiveTo review evidence of existing and new pharmacological therapies for lowering lipoprotein(a) (Lp[a]) concentrations and their impact on clinically relevant outcomes.MethodsWe searched for literature pertaining to Lp(a) and pharmacological treatments in PubMed. We reviewed articles published between 1963 and 2020.ResultsWe found that statins significantly increased Lp(a) concentrations. Therapies that demonstrated varying degrees of Lp(a) reduction included ezetimibe, niacin, proprotein convertase subtilisin/kexin type 9 inhibitors, lipoprotein apheresis, fibrates, aspirin, hormone replacement therapy, antisense oligonucleotide therapy, and small interfering RNA therapy. There was limited data from large observational studies and post hoc analyses showing the potential benefits of these therapies in improving cardiovascular outcomes.ConclusionThere are multiple lipid-lowering agents currently being used to treat hyperlipidemia that also have a Lp(a)-lowering effect. Two RNA therapies specifically targeted to lower Lp(a) are being investigated in phase 3 clinical trials and, thus far, have shown promising results. However, evidence is lacking to determine the clinical relevance of reducing Lp(a). At present, there is a need for large-scale, randomized, controlled trials to evaluate cardiovascular outcomes associated with lowering Lp(a). |
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