Introduction

Br J Cardiol 2024;31(suppl 1):S3doi:10.5837/bjc.2024.s01 Leave a comment
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This sponsored supplement was initiated and funded by Novartis Pharmaceuticals UK Limited. Editorial input and control was retained by the authors and editors; however, Novartis reviewed the material for technical accuracy and compliance with relevant regulatory requirements.

Novartis

Job code: FA-11207700 | June 2024

Raised lipoprotein(a) (Lp[a]) cholesterol is highly prevalent affecting 1 in 5 individuals and is also frequently associated with the inherited condition familial hypercholesterolaemia (FH).1 It is associated with an increased risk of atherosclerotic cardiovascular disease, stroke and peripheral arterial disease, independent of traditional cardiovascular risk factors.2 Accurate measurement of circulating Lp(a) levels is currently a challenge3 and there are no licensed pharmacotherapies available for the management and treatment of elevated Lp(a).4

Lipoprotein(a) – advances in understanding - Introduction

As with all health conditions, effective communication between the healthcare professional and patient is a key component of management. It is important that patients understand that raised Lp(a) is predominantly genetically inherited (>90%)2; therefore, other family members should be screened for the condition5 and made aware of the associated risks. Intensive treatment and management of other cardiovascular risk factors, such as low-density lipoprotein-cholesterol, blood glucose and blood pressure, is recommended. Patients should be mindful of other conditions that might affect their Lp(a) levels, such as chronic kidney disease.5 Lastly, they should be made aware of the factors that can raise their risk of heart disease and be encouraged to eat a healthy diet, maintain a healthy weight, take regular exercise, quit smoking and moderate their alcohol intake.5,6

In this supplement, Professor Paul Durrington discusses the role of Lp(a) in atherosclerotic heart disease and FH, covering the measurement and atherogenicity of Lp(a), along with its clinical management. Dr Saleem Ansari and Dr Jaimini Cegla examine the importance of measuring Lp(a) levels and the indications for Lp(a) testing. Professor Afzar Zaman and colleagues review the clinical utility of Lp(a) from an interventionist perspective, summarising the available data on the modulatory effect of Lp(a) on plaque morphology and recurrent ischaemic events. Finally, I will provide some real-world examples of patients with raised Lp(a) levels, illustrating the key principles of diagnosis and management.

Conflicts of interest

TZK has received an honorarium for working on this supplement.

Tina Z Khan
Consultant Cardiologist
Department of Cardiology
Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust Hospital
Part of Guy’s and St Thomas’
Hill End Road, Harefield, UB9 6JH

([email protected])

Articles in this supplement

Lipoprotein(a) in atherosclerotic heart disease and familial hypercholesterolaemia
Lipoprotein(a) measurement – how, why and in whom?
Clinical utility of lipoprotein(a): an interventionist’s perspective
Raised lipoprotein(a): real-world examples of communication and clinical management

References

1. Loh WJ, Chan DC, Mata P, Watts GF. Familial hypercholesterolemia and elevated lipoprotein(a): cascade testing and other implications for contextual models of care. Front Genet 2022;13:905941. https://doi.org/10.3389/fgene.2022.905941

2. Reyes-Soffer G, Ginsberg HN, Berglund L et al; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; and Council on Peripheral Vascular Disease. Lipoprotein(a): a genetically determined, causal, and prevalent risk factor for atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol 2022;42:e48–e60. https://doi.org/10.1161/ATV.0000000000000147 [Epub online ahead of print]

3. Kronenberg F. Lipoprotein(a) measurement issues: are we making a mountain out of a molehill? Atherosclerosis 2022;349:123–35. https://doi.org/10.1016/j.atherosclerosis.2022.04.008

4. Hu X, Cristino J, Gautam R et al. Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): a real-world US study. Am J Prev Cardiol 2023;14:100476. https://doi.org/10.1016/j.ajpc.2023.100476

5. Cegla J, Neely RDG, France M et al; HEART UK Medical, Scientific and Research Committee. HEART UK consensus statement on lipoprotein(a): a call to action. Atherosclerosis 2019;291:62–70. https://doi.org/10.1016/j.atherosclerosis.2019.10.011 [Epub online ahead of print]

6. Virani SS, Koschinsky ML, Maher L et al. Global think tank on the clinical considerations and management of lipoprotein(a): the top questions and answers regarding what clinicians need to know. Prog Cardiovasc Dis 2022;73:32–40. https://doi.org/10.1016/j.pcad.2022.01.002 [Epub online ahead of print]

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