Key result
Despite achieving very low levels of LDL cholesterol with current therapies, many patients continue to have recurrent cardiovascular events, partly attributable to high lipoprotein(a).
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High lipoprotein(a) is highlighted as a key driver of residual cardiovascular risk in patients who have achieved very low LDL cholesterol levels.
n 1994, the landmark 4S trial (Scandinavian Simvastatin Survival Study) reported that lowering low-density lipoprotein (LDL) cholesterol with simvastatin reduced cardiovascular events in patients with coronary artery disease and hypercholesterolemia. Today, the evidence in favor of LDL cholesterol as a modifiable causal driver of atherosclerosis has never been stronger, and current therapies, such as PCSK9 inhibitors (PCSK9i), can now lower LDL cholesterol to levels never previously seen. But despite achieving very low levels of LDL cholesterol, many patients continue to have recurrent events. Although the residual risk for cardiovascular events is likely multifactorial, in certain patients a key component is a high residual burden of atherogenic lipid particles attributable to high lipoprotein(a) [Lp(a)].
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George Thanassoulis (2019) conducted an editorial in Cardiovascular disease. Screening for High Lipoprotein(a) was evaluated. Despite achieving very low levels of LDL cholesterol with current therapies, many patients continue to have recurrent cardiovascular events, partly attributable to high lipoprotein(a).
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