Lp(a): A Toolkit for Health Care Professionals

10 z In statin-treated patients, high Lp(a) is associated with ASCVD. z In primary prevention for adults ages 40-75 with a 10-year ASCVD risk of 7.5% to 19.9%, risk-enhancing factors favor initiation of statin therapy. If measured, an Lp(a) ≥50 mg/dL or ≥125 nmol/L may be considered a risk-enhancing factor. z In high-risk or very-high-risk patients with LDL-C ≥70 mg/dL (non–HDL-C ≥100 mg/dL) and a Lp(a) ≥50 mg/dL or ≥100 nmol/L on maximally tolerated statin treatment, it’s reasonable to consider more intensive therapies (such as ezetimibe and/or PCSK9 inhibitors) to lower LDL-C (and non–HDL-C) to better reduce ASCVD risk. 19 z The presence of an elevated Lp(a) in patients with very-high-risk ASCVD and baseline LDL-C ≥70 mg/dL or non–HDL-C ≥100 mg/dL despite maximally tolerated statin and ezetimibe therapies may be used as a factor favoring a PCSK9 inhibitor. z Although niacin and hormone replacement therapy can reduce Lp(a) levels, these drugs are not recommended because they haven’t demonstrated ASCVD benefit and may be harmful, according to the NLA scientific statement. 6 z Maximize treatment of modifiable cardiovascular risk factors. z Good adherence to various LDL- lowering diets will reduce LDL-C levels by 10% to >15%. Moderate- intensity statins can be expected to reduce LDL-C levels by another 30% to 49% and high-intensity statins by ≥50%. Adding ezetimibe or bile acid sequestrants to statin therapy typically provides an additional 13% to 30% reduction in LDL-C. Much greater additive reductions occur by adding a PCSK9 inhibitor to statin plus ezetimibe, providing a 43% to 64% reduction. What to KnowWhen Managing Your Patients’ Lp(a) Risk