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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #7 2024

New epidemiological data has shown that the relationship
between baseline Lp(a) level and ASCVD events is continuous Dyslipidaemia
and log-linear, with increased risk even at “lower-risk” levels
(25–50 nmol/L). Despite differences in Lp(a) levels among
racial/ethnic groups as observed in UK Biobank, Lp(a)-
attributable risk is similar, eliminating previous race-based
definitions of elevated Lp(a). The NLA clarifies that because
accepted conversion factors to adjust for Lp(a)-C in LDL-C
calculation have proven inaccurate, this leads to undertreatment
of high-risk patients and such adjustments should not be used.

With regards to management and treatment, the NLA
recommends adoption of a healthy lifestyle as the foundation
of management for all adults and children. In addition, statins
remain first-line therapy for mitigating LDL-C-driven ASCVD risk
in both secondary and high-risk primary prevention patients.
Although statins do not lower Lp(a) and may slightly increase
it, statins clearly lower ASCVD risk and remain the standard
of care. A PCSK-9i may be a good choice if a high-risk patient
needs additional LDL-C lowering after a maximally tolerated
statin therapy to address residual risk from both LDL-C and
Lp(a). Aspirin remains a key recommendation for the secondary
prevention of ASCVD and recent studies have suggested
that individuals with genetically predicted elevated Lp(a) may
derive net benefit from aspirin therapy due to its purported
prothrombotic characteristics.

Finally, for patients with high Lp(a), apheresis, the only FDA-
approved therapy for treating high Lp(a), is recommended,
although the NLA comments that it is not available at all centres
and can be expensive and time-consuming.

The NLA notes that although Lp(a) is an established
independent causal risk factor for cardiovascular disease,
and despite the high prevalence of Lp(a) elevation (~1 of 5
individuals), measurement rates are low, warranting improved
screening strategies for cardiovascular disease prevention and
a need for specific Lp(a)-lowering therapies in the future.

WATCH
PROF. KOSCHINKSKY, LEADING
AUTHOR OF THE NLA UPDATE,
DISCUSS THE ABCS OF
LIPOPROTEIN(A) FROM A RECENT
CLICK HERE LECTURE FOR THE AMERICAN HEART
FOR THE LINK TO FULL ARTICLE ASSOCIATION. (1 HR)

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