Top

Clinical Research in Cardiology Supplements

Published in:

Open Access 01-04-2019 | Nicotinic Acid

Lipoprotein(a)—antisense therapy

Author: Anja Vogt

Published in: Clinical Research in Cardiology Supplements | Special Issue 1/2019

Abstract

Elevated levels of lipoprotein(a) (Lp(a)) contribute to the risk of early and severe cardiovascular disease (CVD) and Lp(a) is acknowledged as a risk factor to be included in risk assessment. The established lipid-modifying medical therapies do not lower Lp(a) except niacin but no data of endpoint trials are available. Of the new lipid-modifying drugs a few have some impact on Lp(a). Whether the Lp(a) lowering effect contributes to the reduction of CVD events would have to be shown in Lp(a) dedicated trials. None of the available agents is indicated to lower Lp(a). Lipoprotein apheresis lowers levels of Lp(a) significantly by >60% per treatment. Trial data and data of the German Lipoprotein Apheresis Registry show that regular apheresis reduces cardiovascular events. The Apo(a) antisense oligonucleotide is the only approach to specifically lower Lp(a). The IONIS-APO(a)_Rx phase 1 and 2 trials showed very substantial decreases of Lp(a) and good tolerability. The hepatospecific variant IONIS-APO(a)-L_Rx is 30 times more potent. The results of the IONIS-APO(a)-L_Rx phase 2 trial were presented recently. The highest dosages reduced Lp(a) by 72 and 80%; in about 81 and 98% Lp(a) levels <50 mg/dl were achieved. Tolerability and safety were confirmed, whereby injection site reactions were the most common side effects. This raises hope that the planned phase 3 trial will reproduce these findings and show a reduction of cardiovascular events.

Berg K (1963) A new serum type system in man—the Lp system. Acta Pathol Microbiol Scand 59:369–382CrossRefPubMed

Erqou S, Thompson A, Di Angelantonio E, Saleheen D, Kaptoge S, Marcovina S, Danesh J (2010) Apolipoprotein(a) isoforms and the risk of vascular disease: systematic review of 40 studies involving 58,000 participants. J Am Coll Cardiol 55(19):2160–2167. https://doi.org/10.1016/j.jacc.2009.10.080 CrossRefPubMed

Kamstrup PR, Benn M, Tybjaerg-Hansen A, Nordestgaard BG (2008) Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population: the Copenhagen City Heart Study. Circulation 117(2):176–184. https://doi.org/10.1161/CIRCULATIONAHA.107.715698 CrossRefPubMed

Laschkolnig A, Kollerits B, Lamina C, Meisinger C, Rantner B, Stadler M, Peters A, Koenig W, Stockl A, Dahnhardt D, Boger CA, Kramer BK, Fraedrich G, Strauch K, Kronenberg F (2014) Lipoprotein (a) concentrations, apolipoprotein (a) phenotypes, and peripheral arterial disease in three independent cohorts. Cardiovasc Res 103(1):28–36. https://doi.org/10.1093/cvr/cvu107 CrossRefPubMedPubMedCentral

Kamstrup PR, Tybjaerg-Hansen A, Nordestgaard BG (2014) Elevated lipoprotein(a) and risk of aortic valve stenosis in the general population. J Am Coll Cardiol 63(5):470–477. https://doi.org/10.1016/j.jacc.2013.09.038 CrossRef

Kronenberg F, Utermann G (2013) Lipoprotein(a): resurrected by genetics. J Intern Med 273(1):6–30. https://doi.org/10.1111/j.1365-2796.2012.02592.x CrossRef

Clarke R, Peden JF, Hopewell JC, Kyriakou T, Goel A, Heath SC, Parish S, Barlera S, Franzosi MG, Rust S, Bennett D, Silveira A, Malarstig A, Green FR, Lathrop M, Gigante B, Leander K, de Faire U, Seedorf U, Hamsten A, Collins R, Watkins H, Farrall M, Consortium P (2009) Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N Engl J Med 361(26):2518–2528. https://doi.org/10.1056/NEJMoa0902604 CrossRefPubMed

Kamstrup PR, Tybjaerg-Hansen A, Steffensen R, Nordestgaard BG (2009) Genetically elevated lipoprotein(a) and increased risk of myocardial infarction. JAMA 301(22):2331–2339. https://doi.org/10.1001/jama.2009.801 CrossRefPubMed

Kraft HG, Lingenhel A, Kochl S, Hoppichler F, Kronenberg F, Abe A, Muhlberger V, Schonitzer D, Utermann G (1996) Apolipoprotein(a) kringle IV repeat number predicts risk for coronary heart disease. Arterioscler Thromb Vasc Biol 16(6):713–719CrossRefPubMed

10.

Kronenberg F, Kronenberg MF, Kiechl S, Trenkwalder E, Santer P, Oberhollenzer F, Egger G, Utermann G, Willeit J (1999) Role of lipoprotein(a) and apolipoprotein(a) phenotype in atherogenesis: prospective results from the Bruneck study. Circulation 100(11):1154–1160CrossRefPubMed

11.

Kronenberg F, Neyer U, Lhotta K, Trenkwalder E, Auinger M, Pribasnig A, Meisl T, Konig P, Dieplinger H (1999) The low molecular weight apo(a) phenotype is an independent predictor for coronary artery disease in hemodialysis patients: a prospective follow-up. J Am Soc Nephrol 10(5):1027–1036PubMed

12.

Sandholzer C, Saha N, Kark JD, Rees A, Jaross W, Dieplinger H, Hoppichler F, Boerwinkle E, Utermann G (1992) Apo(a) isoforms predict risk for coronary heart disease. A study in six populations. Arterioscler Thromb 12(10):1214–1226CrossRefPubMed

13.

Authors/Task Force M, Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FD, Lochen ML, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WM, Additional Contributor: Simone B, Document R, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GY, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Ryden L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL (2016) 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 23 (11):NP1–NP96. https://doi.org/10.1177/2047487316653709

14.

Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr., Sperling L, Virani SS, Yeboah J (2018) 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2018.11.002 CrossRefPubMed

15.

Nordestgaard BG, Chapman MJ, Ray K, Boren J, Andreotti F, Watts GF, Ginsberg H, Amarenco P, Catapano A, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Reiner Z, Taskinen MR, Tokgozoglu L, Tybjaerg-Hansen A (2010) Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J 31(23):2844–2853. https://doi.org/10.1093/eurheartj/ehq386 CrossRefPubMedPubMedCentral

16.

Khera AV, Everett BM, Caulfield MP, Hantash FM, Wohlgemuth J, Ridker PM, Mora S (2014) Lipoprotein(a) concentrations, rosuvastatin therapy, and residual vascular risk: an analysis from the JUPITER Trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin). Circulation 129(6):635–642. https://doi.org/10.1161/CIRCULATIONAHA.113.004406 CrossRefPubMed

17.

Kei A, Liberopoulos E, Tellis K, Rizzo M, Elisaf M, Tselepis A (2013) Effect of hypolipidemic treatment on emerging risk factors in mixed dyslipidemia: a randomized pilot trial. Eur J Clin Invest 43(7):698–707. https://doi.org/10.1111/eci.12095 CrossRefPubMed

18.

Tziomalos K, Athyros VG, Wierzbicki AS, Mikhailidis DP (2009) Lipoprotein a: where are we now? Curr Opin Cardiol 24(4):351–357. https://doi.org/10.1097/HCO.0b013e32832ac21a CrossRefPubMed

19.

Moutzouri E, Liberopoulos EN, Tellis CC, Milionis HJ, Tselepis AD, Elisaf MS (2013) Comparison of the effect of simvastatin versus simvastatin/ezetimibe versus rosuvastatin on markers of inflammation and oxidative stress in subjects with hypercholesterolemia. Atherosclerosis 231(1):8–14. https://doi.org/10.1016/j.atherosclerosis.2013.08.013 CrossRefPubMed

20.

Carlson LA, Hamsten A, Asplund A (1989) Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid. J Intern Med 226(4):271–276CrossRefPubMed

21.

Goldberg A, Alagona P Jr., Capuzzi DM, Guyton J, Morgan JM, Rodgers J, Sachson R, Samuel P (2000) Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol 85(9):1100–1105CrossRefPubMed

22.

Bruckert E, Labreuche J, Amarenco P (2010) Meta-analysis of the effect of nicotinic acid alone or in combination on cardiovascular events and atherosclerosis. Atherosclerosis 210(2):353–361. https://doi.org/10.1016/j.atherosclerosis.2009.12.023 CrossRefPubMed

23.

Group HTC, Landray MJ, Haynes R, Hopewell JC, Parish S, Aung T, Tomson J, Wallendszus K, Craig M, Jiang L, Collins R, Armitage J (2014) Effects of extended-release niacin with laropiprant in high-risk patients. N Engl J Med 371(3):203–212. https://doi.org/10.1056/NEJMoa1300955 CrossRef

24.

Bundesausschuss G (2010) Richtlinie des Gemeinsamen Bundesausschusses zu Untersuchungs- und Behandlungsmethoden der vertragsärztlichen Versorgung. Bundesanzeiger 109:2561

25.

Derfler K, Steiner S, Sinzinger H (2015) Lipoprotein-apheresis: Austrian consensus on indication and performance of treatment. Wien Klin Wochenschr 127(15–16):655–663. https://doi.org/10.1007/s00508-015-0833-4 CrossRefPubMed

26.

Stefanutti C (2010) The 2009 2nd Italian Consensus Conference on LDL-apheresis. Nutr Metab Cardiovasc Dis 20(10):761–762. https://doi.org/10.1016/j.numecd.2010.04.007 CrossRefPubMed

27.

Thompson GR (2008) Recommendations for the use of LDL apheresis. Atherosclerosis 198(2):247–255. https://doi.org/10.1016/j.atherosclerosis.2008.02.009 CrossRefPubMed

28.

Jaeger BR, Richter Y, Nagel D, Heigl F, Vogt A, Roeseler E, Parhofer K, Ramlow W, Koch M, Utermann G, Labarrere CA, Seidel D, Group of (2009) Longitudinal cohort study on the effectiveness of lipid apheresis treatment to reduce high lipoprotein(a) levels and prevent major adverse coronary events. Nat Clin Pract Cardiovasc Med 6(3):229–239. https://doi.org/10.1038/ncpcardio1456 CrossRefPubMed

29.

Rosada A, Kassner U, Vogt A, Willhauck M, Parhofer K, Steinhagen-Thiessen E (2014) Does regular lipid apheresis in patients with isolated elevated lipoprotein(a) levels reduce the incidence of cardiovascular events? Artif Organs 38(2):135–141. https://doi.org/10.1111/aor.12135 CrossRefPubMed

30.

Schettler VJ, Neumann CL, Peter C, Zimmermann T, Julius U, Roeseler E, Heigl F, Ramlow W, Blume H, Scientific Board of GftGAWG (2015) First data from the German Lipoprotein Apheresis Registry (GLAR). Atheroscler Suppl 18:41–44. https://doi.org/10.1016/j.atherosclerosissup.2015.02.006 CrossRefPubMed

31.

Schettler VJJ, Neumann CL, Peter C, Zimmermann T, Julius U, Roeseler E, Heigl F, Grutzmacher P, Blume H, Scientific Board of GftGAWG (2017) Current insights into the German Lipoprotein Apheresis Registry (GLAR)—Almost 5 years on. Atheroscler Suppl 30:50–55. https://doi.org/10.1016/j.atherosclerosissup.2017.05.006 CrossRef

32.

Leebmann J, Roeseler E, Julius U, Heigl F, Spitthoever R, Heutling D, Breitenberger P, Maerz W, Lehmacher W, Heibges A, Klingel R, ProLiFe Study G (2013) Lipoprotein apheresis in patients with maximally tolerated lipid-lowering therapy, lipoprotein(a)-hyperlipoproteinemia, and progressive cardiovascular disease: prospective observational multicenter study. Circulation 128(24):2567–2576. https://doi.org/10.1161/CIRCULATIONAHA.113.002432 CrossRefPubMed

33.

Roeseler E, Julius U, Heigl F, Spitthoever R, Heutling D, Breitenberger P, Leebmann J, Lehmacher W, Kamstrup PR, Nordestgaard BG, Maerz W, Noureen A, Schmidt K, Kronenberg F, Heibges A, Klingel R, ProLiFe-Study G (2016) Lipoprotein apheresis for lipoprotein(a)-associated cardiovascular disease: prospective 5 years of follow-up and apolipoprotein(a) characterization. Arterioscler Thromb Vasc Biol 36(9):2019–2027. https://doi.org/10.1161/ATVBAHA.116.307983 CrossRefPubMed

34.

Safarova MS, Ezhov MV, Afanasieva OI, Matchin YG, Atanesyan RV, Adamova IY, Utkina EA, Konovalov GA, Pokrovsky SN (2013) Effect of specific lipoprotein(a) apheresis on coronary atherosclerosis regression assessed by quantitative coronary angiography. Atheroscler Suppl 14(1):93–99. https://doi.org/10.1016/j.atherosclerosissup.2012.10.015 CrossRefPubMed

35.

von Dryander M, Fischer S, Passauer J, Muller G, Bornstein SR, Julius U (2013) Differences in the atherogenic risk of patients treated by lipoprotein apheresis according to their lipid pattern. Atheroscler Suppl 14(1):39–44. https://doi.org/10.1016/j.atherosclerosissup.2012.10.005 CrossRef

36.

Winters JL (2011) Lipid apheresis, indications, and principles. J Clin Apher 26(5):269–275. https://doi.org/10.1002/jca .20299CrossRefPubMed

37.

Sabatine MS, Giugliano RP, Wiviott SD, Raal FJ, Blom DJ, Robinson J, Ballantyne CM, Somaratne R, Legg J, Wasserman SM, Scott R, Koren MJ, Stein EA, Open-Label Study of Long-Term Evaluation against LDLCI (2015) Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med. https://doi.org/10.1056/NEJMoa1500858 CrossRefPubMed

38.

Robinson JG, Farnier M, Krempf M, Bergeron J, Luc G, Averna M, Stroes ES, Langslet G, Raal FJ, Shahawy ME, Koren MJ, Lepor NE, Lorenzato C, Pordy R, Chaudhari U, Kastelein JJ, Investigators OLT (2015) Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N Engl J Med. https://doi.org/10.1056/NEJMoa1501031 CrossRefPubMedPubMedCentral

39.

Gaudet D, Kereiakes DJ, McKenney JM, Roth EM, Hanotin C, Gipe D, Du Y, Ferrand AC, Ginsberg HN, Stein EA (2014) Effect of alirocumab, a monoclonal proprotein convertase subtilisin/kexin 9 antibody, on lipoprotein(a) concentrations (a pooled analysis of 150 mg every two weeks dosing from phase 2 trials). Am J Cardiol 114(5):711–715. https://doi.org/10.1016/j.amjcard.2014.05.060 CrossRefPubMed

40.

Raal FJ, Honarpour N, Blom DJ, Hovingh GK, Xu F, Scott R, Wasserman SM, Stein EA, Investigators T (2015) Inhibition of PCSK9 with evolocumab in homozygous familial hypercholesterolaemia (TESLA Part B): a randomised, double-blind, placebo-controlled trial. Lancet 385(9965):341–350. https://doi.org/10.1016/S0140-6736(14)61374-X CrossRefPubMed

41.

Desai NR, Kohli P, Giugliano RP, O’Donoghue ML, Somaratne R, Zhou J, Hoffman EB, Huang F, Rogers WJ, Wasserman SM, Scott R, Sabatine MS (2013) AMG145, a monoclonal antibody against proprotein convertase subtilisin kexin type 9, significantly reduces lipoprotein(a) in hypercholesterolemic patients receiving statin therapy: an analysis from the LDL-C Assessment with Proprotein Convertase Subtilisin Kexin Type 9 Monoclonal Antibody Inhibition Combined with Statin Therapy (LAPLACE)-Thrombolysis in Myocardial Infarction (TIMI) 57 trial. Circulation 128(9):962–969. https://doi.org/10.1161/CIRCULATIONAHA.113.001969 CrossRefPubMed

42.

O’Donoghue ML, Fazio S, Giugliano RP, Stroes ESG, Kanevsky E, Gouni-Berthold I et al (2018) Lipoprotein(a), PCSK9 inhibition and cardiovascular risk: insights from the FOURIER trial. Circulation. https://doi.org/10.1161/CIRCULATIONAHA.118.037184 CrossRef

43.

Parhofer KG (2012) Mipomersen: evidence-based review of its potential in the treatment of homozygous and severe heterozygous familial hypercholesterolemia. Core Evid 7:29–38. https://doi.org/10.2147/CE.S25239 CrossRefPubMedPubMedCentral

44.

Rader DJ, Kastelein JJ (2014) Lomitapide and mipomersen: two first-in-class drugs for reducing low-density lipoprotein cholesterol in patients with homozygous familial hypercholesterolemia. Circulation 129(9):1022–1032. https://doi.org/10.1161/CIRCULATIONAHA.113.001292 CrossRefPubMed

45.

Santos RD, Raal FJ, Catapano AL, Witztum JL, Steinhagen-Thiessen E, Tsimikas S (2015) Mipomersen, an antisense oligonucleotide to apolipoprotein B‑100, reduces lipoprotein(a) in various populations with hypercholesterolemia: results of 4 phase III trials. Arterioscler Thromb Vasc Biol 35(3):689–699. https://doi.org/10.1161/ATVBAHA.114.304549 CrossRefPubMedPubMedCentral

46.

Waldmann E, Vogt A, Crispin A, Altenhofer J, Riks I, Parhofer KG (2017) Effect of mipomersen on LDL-cholesterol in patients with severe LDL-hypercholesterolaemia and atherosclerosis treated by lipoprotein apheresis (The MICA-Study). Atherosclerosis 259:20–25. https://doi.org/10.1016/j.atherosclerosis.2017.02.019 CrossRefPubMed

47.

Waldmann E, Vogt A, Crispin A, Altenhofer J, Riks I, Parhofer KG (2018) Corrigendum to: “Effect of mipomersen on LDL-cholesterol in patients with severe LDL-hypercholesterolaemia and atherosclerosis treated by lipoprotein apheresis (The MICA-Study). Atherosclerosis 275:461–462. https://doi.org/10.1016/j.atherosclerosis.2018.05.020 CrossRefPubMed

48.

Merki E, Graham M, Taleb A, Leibundgut G, Yang X, Miller ER, Fu W, Mullick AE, Lee R, Willeit P, Crooke RM, Witztum JL, Tsimikas S (2011) Antisense oligonucleotide lowers plasma levels of apolipoprotein (a) and lipoprotein (a) in transgenic mice. J Am Coll Cardiol 57(15):1611–1621. https://doi.org/10.1016/j.jacc.2010.10.052 CrossRefPubMed

49.

Tsimikas S, Viney NJ, Hughes SG, Singleton W, Graham MJ, Baker BF, Burkey JL, Yang Q, Marcovina SM, Geary RS, Crooke RM, Witztum JL (2015) Antisense therapy targeting apolipoprotein(a): a randomised, double-blind, placebo-controlled phase 1 study. Lancet 386(10002):1472–1483. https://doi.org/10.1016/S0140-6736(15)61252-1 CrossRefPubMed

50.

Prakash TP, Graham MJ, Yu J, Carty R, Low A, Chappell A, Schmidt K, Zhao C, Aghajan M, Murray HF, Riney S, Booten SL, Murray SF, Gaus H, Crosby J, Lima WF, Guo S, Monia BP, Swayze EE, Seth PP (2014) Targeted delivery of antisense oligonucleotides to hepatocytes using triantennary N‑acetyl galactosamine improves potency 10-fold in mice. Nucleic Acids Res 42(13):8796–8807. https://doi.org/10.1093/nar/gku531 CrossRefPubMedPubMedCentral

51.

Viney NJ, van Capelleveen JC, Geary RS, Xia S, Tami JA, Yu RZ, Marcovina SM, Hughes SG, Graham MJ, Crooke RM, Crooke ST, Witztum JL, Stroes ES, Tsimikas S (2016) Antisense oligonucleotides targeting apolipoprotein(a) in people with raised lipoprotein(a): two randomised, double-blind, placebo-controlled, dose-ranging trials. Lancet 388(10057):2239–2253. https://doi.org/10.1016/S0140-6736(16)31009-1 CrossRefPubMed

52.

Tsimikas S, Karwatowska-Prokopczuk E, Gouni-Berthold I, Tardif JC, Baum S, Steinhagen-Thiessen E, Shapiro M, Stroes E, Moriarty P, Nordestgaard B, Guerriero J, Viney N, O’Dea L, Witztum J, AKCEA-APO(a)-LRx Study Investigators (2018) Safety and efficacy of AKCEA-APO(a)-LRx to lower lipoprotein(a) levels in patients with established cardiovascular disease: A phase 2 dose-ranging trial. https://www.tctmd.com/slide/safety-and-efficacy-akcea-apoa-lrx-lower-lipoproteina-levels-patients-established. Accessed 14 Jan 2019

Title: Lipoprotein(a)—antisense therapy
Author: Anja Vogt
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keywords: Nicotinic Acid
Evolocumab
Arterial Occlusive Disease
Published in: Clinical Research in Cardiology Supplements / Issue Special Issue 1/2019
Print ISSN: 1861-0706
Electronic ISSN: 1861-0714
DOI: https://doi.org/10.1007/s11789-019-00096-2

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Lipoprotein(a)—antisense therapy

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2019

Is lipoprotein(a) a risk factor for ischemic stroke and venous thromboembolism?

Lipoprotein(a) and proprotein convertase subtilisin/kexin type 9 inhibitors

Lipoprotein(a) apheresis in patients with peripheral arterial disease: rationale and clinical results

Lipoprotein(a) and mortality—a high risk relationship

Prediction of cardiovascular risk by Lp(a) concentrations or genetic variants within the LPA gene region

Lipoprotein(a)

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page