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Clinical Research in Cardiology Supplements

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Open Access 01-04-2019 | PCSK9 Inhibitor

Lipoprotein(a)—an interdisciplinary challenge

Authors: U. Julius, S. Tselmin, U. Schatz, S. Fischer, S. R. Bornstein

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

Abstract

Lipoprotein(a) (Lp(a)) is an internationally recognized atherogenic risk factor which is inherited and not changed by nutrition or physical activity. At present, only proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors may modestly decrease its concentration (but not in all patients)—leading to a certain decrease in cardiovascular events (CVE) in controlled studies. However, at present an elevation of Lp(a) is not a generally accepted indication for their use. More effective is lipoprotein apheresis (LA) therapy with respect to both lowering Lp(a) levels and reduction of CVE. In the future, an antisense oligonucleotide against apolipoprotein(a) will probably be available. Atherosclerosis in patients with an elevation of Lp(a) may affect several vessel regions (carotids, aorta, coronaries, leg arteries). Thus, Lp(a) should be measured in high-risk patients. These patients are usually cared for by their family doctors and by other specialists who should closely cooperate. Lipidologists should decide whether costly therapies like PCSK9 inhibitors or LA should be started. The main aim of current therapy is to optimize all other risk factors (LDL cholesterol, hypertension, diabetes mellitus, body weight, renal insufficiency). Patients should be regularly monitored (lab data, heart, arteries). This paper describes the duties of physicians of different specialties when caring for patients with high Lp(a) concentrations.

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Title: Lipoprotein(a)—an interdisciplinary challenge
Authors: U. Julius
S. Tselmin
U. Schatz
S. Fischer
S. R. Bornstein
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Keywords: PCSK9 Inhibitor
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/s11789-019-00098-0

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