Hypolipidaemic treatment in patients with elevated lipoprotein (a)

Background and Aims: Aim: To evaluate the effect of hypolipidaemic therapies in patients with elevated levels of lipoprotein(a) [Lp(a)]. Methods: Materials and Methods: A prospective study including 70 patients at high cardiovascular risk with elevated Lp(a) levels (>30 mg/dL) attending a Lipid Clinic in Greece. Subjects were allocated to the following therapies according to national guidelines for cholesterol management: high-intensity statin monotherapy (n=28), ezetimibe added to high-intensity statin (n=31), and PCSK9 inhibitor added to high-intensity statin plus ezetimibe (n=11). Follow-up duration was 3 months. We investigated the effect of the lipid-lowering interventions on subjects’ lipidemic and glycemic profile. Comparisons between two groups were adjusted for the baseline levels of the studied parameters. Results: Results: Subjects’ mean age was 51 ± 15 years, 40% were male, 39% were diagnosed with familial hypercholesterolaemia, 16% with atherosclerotic cardiovascular disease, while 36%, 33% and 15% were at very high, high, and moderate cardiovascular risk, respectively. All interventions significantly reduced apolipoprotein B, total and LDL cholesterol, but only PCSK9 inhibitors reduced significantly Lp(a) (Table). PCSK9 inhibitors achieved the highest reduction in LDL cholesterol (-56% vs -43% vs -22%, respectively, p<0.05) and Lp(a) levels (-28% vs +11% vs +17%, respectively, p<0.05) compared with ezetimibe and statin monotherapy, respectively (Table). No significant effect on subjects’ glycemic profile across treatment groups was noted. Conclusions: Conclusions: PCSK9 inhibitors achieved the highest LDL cholesterol reduction compared with high-intensity statin ± ezetimibe and the only to lower significantly Lp(a).