2018 Scientific Sessions: Lipoprotein(a) as a Risk Factor and Treatment Target for CVD

Lipoprotein(a) as a Risk Factor and Treatment Target for CVD

Lp(a) Function and Metabolism: Identification and Closing of Knowledge Gaps
Marlys L. Koschinsky, PhD
Scientific & Executive Director
Robarts Research Institute
Schulich School of Medicine & Dentistry
Western University
London, ON, Canada

In this presentation, Marlys Koschinsky, PhD, illustrated that elevated Lp(a) is a prevalent and independent risk factor of cardiovascular disease. Many unanswered questions still remain concerning regulation of Lp(a) biosynthesis and catabolism.

Many potential pathogenic mechanisms for Lp(a) have been proposed, relating to atherosclerosis, inflammation and thrombosis. The strongest evidence is for a role for oxPL in promoting maladaptive inflammatory responses underlying both atherosclerosis and aortic valve calcification.

Dr. Koschinsky concluded that while many mysteries remain surrounding Lp(a), we are on the cusp of considering elevated Lp(a) to be a modifiable risk factor.
 

Challenges in Lp(a) Measurement
Santica Marcovina, PhD, DSc
Research Professor, Medicine
Division of Metabolism, Endocrinology and Nutrition
University of Washington
Seattle, WA

With the unanswered questions surrounding Lp(a), Santica Marcovina, PhD, DSc, presented the challenge of Lp(a) measurement and current recommendations on best approaches. Her presentation covered structural characteristics of Lp(a), the impact of measurement on Lp(a) levels, assay characteristics and limitations, units to express Lp(a) concentration, variability of Lp(a) distribution by race/ethnicity and new Lp(a)-specific interventions and future clinical trials.

Take home messages from this presentation included:

• New, exciting outcomes from the future intervention studies on Lp(a) are expected
• Common expression of Lp(a) values and use of well-validated assays will be required to evaluate the patients’ response to therapy

Present and Future Therapy for Lp(a)
Patrick M. Moriarty, MD, FNLA
Professor of Medicine
Director of Clinical Pharmacology
University of Kansas Medical Center
Kansas City, KS

What therapeutic approaches for Lp(a) are there currently and what does the future hold? Patrick Moriarty, MD, FNLA showed in this presentation that though Lp(a) is an independent risk factor for CVD, with 7 million to 1 billion people worldwide with elevated level, few therapies currently exist in lowering Lp(a).

Presently, only lipid-apheresis has demonstrated reduction of Lp(a) levels and CVD events. Dr. Moriarty concluded that future therapy such as antisense AB and RNA interference may offer appropriate treatment.