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Lipoprotein(a) is a low-density lipoprotein-like particle that carries oxidized phospholipids and has proinflammatory and proatherogenic properties. In prospective studies, higher levels of lipoprotein(a) are associated with significantly higher risk of atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality.1 In a meta-analysis of 29 069 patients, the incidence of ASCVD events per 1000 person-years was 80.0 (95% CI, 75.3-84.9) among people with lipoprotein(a) greater than or equal to 50 mg/dL and 55.3 (95% CI, 53.4-57.3) for people with lipoprotein(a) less than 15 mg/dL (adjusted hazard ratio, 1.35 [95% CI, 1.11-1.66]).2 A similar association of elevated lipoprotein(a) with ASCVD was observed among 460 506 participants from the UK Biobank study.3 Medications such as pelacarsen, olpasiran, and lepodisiran reduce lipoprotein(a) production in the liver and lower plasma lipoprotein(a) by up to 99%, and are currently undergoing testing in randomized clinical trials to determine whether they reduce rates of ASCVD in people with elevated lipoprotein(a).4
