Lipoprotein(a): Treatment of a Novel Risk Factor for Cardiovascular Disease

Within the last years, Lipoprotein(a) - Lp(a) - has emerged as a genetic, independent and most likely causal risk factor for cardiovascular disease and calcific aortic valve stenosis. It exerts proatherogenic, prothrombotic and proinflammatory effects that increase cardiovascular risk. Diagnostics of Lp(a) hyperlipoproteinemia poses various problems, such as the reproducibility between different assays and lack of a standardized threshold identifying pathologic serum levels of Lp(a). Until now, the invasive lipoprotein apheresis is the only treatment inducing a moderate decrease of Lp(a) serum concentrations. The first specific therapies based on RNA-targeted strategies are currently tested in phase III trials. Ongoing randomized controlled trials will improve our understanding of the pathophysiological significance of Lp(a) independent of LDL cholesterol levels.