What we know from Lp(a)HORIZON and what remains unknown

“HORIZON may have had some of the best-treated patients of any recent cardiovascular outcomes trial. Baseline LDL-C was about 65 mg/dL, a measured LDL-C contains the cholesterol carried on Lp(a), so in reality, 15-20 points lower. In patients with very high Lp(a), if you correct LDL-C for Lp(a)-cholesterol, the actual LDL-C carried by LDL particles may have been closer to 45–50 mg/dL, perhaps even lower in some patients. This raises a very basic question:Can you still demonstrate a major incremental benefit from lowering another apoB-containing particle when the underlying LDL burden has already been driven this low?”

George ThanassoulisAssociate Professor of Medicine, McGill University

“In this study, patients actually had very well-controlled risk factors, including their LDL [low-density lipoprotein] cholesterol. If you control all of the risk factors and you reduce risk in every other way, is there enough residual risk from Lp(a) to make a difference?”

“Yeah, and if low LDL is the group of people going into the trial, your benefit from marginal risk reduction from a lipid perspective is just going to necessarily be lower. And I think that that’s one of the major takeaways that I have, is that people who are well-treated, you should continue to treat them well. And if somebody is not well-treated, this to me is a call to action that even if a patient has a very high Lp(a) and all of the associated risk that is related to their family history and the internal concern about what that value means for them, that we can do a pretty damn good job of treating them if we just use the traditional things that we have access to, we know how to prescribe, and we know that they work really well.”