Table 2.
Effects of Different Lipid-Lowering Drugs on Lp(a) Levels, Production and Catabolic Rates in Turnover Studies and Effects on CVD Outcomes Either Combined with LDL-C Changes or if Analyzed for Heterogeneity by Lp(a) Level Within Trials. Lp(a) Specific Studies are Quoted Separately
| Intervention | Baseline Lp(a) | Change in Lp(a) | Change in Production Rate (%) | Change in Fractional Catabolic Rate (%) | Change in CVD Events |
|---|---|---|---|---|---|
| Apheresis | Usually >100nM | NA | NA | NA | 54–90% (include LDL-C effect) |
| Apheresis Lp(a) study76 | 108nM | 68% | NA | NA | 81% (includes LDL-C effect) |
| Statins | Variable | Nil but distribution shift | NA | NA | No differential |
| Fibrates | Variable | −2.7mg/dL | NA | NA | No differential |
| Niacin | Variable | −23% | −50 | −37 | No differential |
| Niacin Lp(a) analysis (THRIVE)90 | 128nM | −31% (12–34nM) | NA | NA | No differential |
| PCSK9 inhibitor | Mean 21 or 25nM | −25 to 27% | Reduced (monotherapy only) | Reduced (combination with statin only) | No clear differential |
| Mipomersen (apoB antisense oligonucleotide) | Not stated | −26% | Nil | −27 | NA |
| CETP inhibitor | Variable | −5% dalcetrapib (low efficacy) -30 to 40% (high efficacy) |
−41% | Nil | No differential |
Abbreviations: CETP, cholesterol ester transfer protein; MTP, microsomal transfer protein; PCSK9, proprotein convertase subtilisin kexin 9.