Lipoprotein(a) – An independent causal risk factor for cardiovascular disease and current therapeutic options

It is widely accepted that elevated levels of lipoprotein(a) (Lp(a)) are associated with an increased risk for cardiovascular diseases. Several studies have identified Lp(a) as independent cardiovascular risk factor. Consequently, therapeutic concepts are targeting at lowering Lp(a) serum levels. To date, in Europe no pharmaceutical treatment to lower levels of Lp(a) is available. Current developments of pharmaceutical agents like the apolipoprotein-(B-100)-antisense mipomersen, inhibitors of PCSK9 and apolipoprotein-(a)-antisense have shown promising results in lowering Lp(a). Presently, the only available therapy to effectively reduce levels of Lp(a) is regular extracorporeal lipoprotein apheresis. Different apheresis methods show a similar lowering effect of about 60–70 % by a single session. Apart from one small-scale study there has been no randomized, controlled study which could prove that lowering Lp(a) will result in a risk reduction for cardiovascular disease. This review looks into the current scientific evidence ofi) Lp(a) as an independent cardiovascular risk factor;ii) risk stratification for Lp(a), especially which patients should be screened;iii) lipoprotein apheresis effectiveness in lowering Lp(a) levels as well as cardiovascular outcome parameters;iv) new pharmaceutical agents targeting at lowering Lp(a) serum levels.