Lp(a): A Toolkit for Health Care Professionals

17 To answer these and a myriad other questions, it’s encouraging that a randomized, placebo-controlled, double blind trial of Lp(a) reduction- Lp(a) Horizon, using antisense oligonucleotides to block the production of Lp(a), is currently being conducted worldwide and results of outcome studies may be available in 2024. Pharmaceutical companies are developing other promising Lp(a)- lowering therapies such as small interfering RNA inhibitor technology. If these early studies continue to show safety and efficacy, it’s likely that more randomized trials will be conducted with the aim to reduce ASCVD and possibly AVS progression through novel targeted Lp(a) reduction. This underscores an urgent need for better standardization of Lp(a) measurement and an improved understanding of Lp(a) metabolism, physiology and the pathologic mechanisms by which Lp(a) and oxidized phospholipids on Lp(a) lead to ASCVD and AVS. Finally, we need to address the knowledge gaps for unique populations, including the possible relationship of high Lp(a) with stroke in children and to better define the unmet medical needs for Lp(a) reduction in people of all ethnicities. Additional data are urgently needed in people who are Black, South Asian or of Hispanic descent. The AHA/ACC guidelines are designed to stimulate a thoughtful, global discussion that will result in improved health and outcomes for those entrusted to our care. 6