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Lipoprotein(a)—It Is Risky, but What Do We Do About It?

  • Lipids (E. Michos, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Lipoprotein(a) [Lp(a)] is a pro-inflammatory, pro-thrombotic, and pro-atherogenic lipoprotein particle. Lp(a) binds and transports oxidized phospholipids in the bloodstream. It is one of the strongest genetic risk factors for coronary artery disease, stroke, and calcific aortic valve stenosis.

Recent Findings

Elevated Lp(a) levels, or hyperlipoproteinemia(a), is associated with cardiovascular outcomes even in high-risk individuals who achieve their low-density lipoprotein cholesterol target with statins. Lifestyle modification therapy and dietary supplements have little impact on plasma Lp(a) levels. However, in individuals with hyperlipoproteinemia(a), the adherence to ideal cardiovascular health metrics (not smoking, having a healthy diet, being physically active, having a normal body mass index, having a normal blood pressure as well as blood sugar and cholesterol levels) might reduce the cardiovascular risk associated with elevated Lp(a) levels. Cardiovascular drugs such as proprotein convertase subtilisin/kexin type 9 inhibitors and niacin provide modest reductions in Lp(a) levels. Lp(a)-targeted therapies are currently being developed, and their impact on cardiovascular risk is yet to be determined.

Summary

In the absence of approved Lp(a)-targeted therapies, a holistic approach combining strict control of traditional cardiovascular risk factors and the adequate management of lifestyle-related risk factors is likely to significantly reduce cardiovascular risk in patients with hyper-Lp(a).

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Acknowledgements

We would like to thank Dr. Patricia Mitchell for the helpful comments on this manuscript.

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Authors and Affiliations

  1. Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Y-3106, Pavillon Marguerite D’Youville, 2725 chemin Ste-Foy, QC, Québec, G1V 4G5, Canada

    Audrey-Anne Després & Benoit J. Arsenault

  2. Department of Medicine, Faculty of Medicine, Université Laval, Québec, Canada

    Audrey-Anne Després & Benoit J. Arsenault

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  1. Audrey-Anne Després
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  2. Benoit J. Arsenault
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Correspondence to Benoit J. Arsenault.

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Conflict of Interest

Audrey-Anne Després is supported by a master’s training award from the Fonds de recherche du Québec: Santé (FRQS) and Canadian Institutes of Health Research and declares no conflicts of interest. Benoit Arsenault holds a junior scholar award from the FRQS and has received research funding from the Canadian Institutes of Health Research (FRN155226 and FRN149068), Pfizer, Merck and Ionis Pharmaceuticals.

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Després, AA., Arsenault, B.J. Lipoprotein(a)—It Is Risky, but What Do We Do About It?. Curr Cardiovasc Risk Rep 12, 27 (2018). https://doi.org/10.1007/s12170-018-0592-7

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