High lipoprotein(a) increases CVD risk regardless of statin treatment

  • Willeit P & al.
  • Lancet
  • 13 Oct 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Cardiovascular disease (CVD) risk increases in patients taking statins who have increased levels of lipoprotein(a) (LPA) at baseline or on treatment, regardless of other CVD risk factors.

Why this matters

  • High LPA is a genetic risk factor that seems to hold residual risk even for patients on statins.
  • Editorial calls the finding “ pivotal   and in keeping with early reports from 2 other trials, ODYSSEY OUTCOMES and FOURIER .
  • Editorial: Guidelines are “guarded” on LPA.

Key results

  • Initiating statin therapy had no appreciable effect on LPA levels.
  • The risk association between CVD and LPA was “approximately linear.”
  • With baseline LPA of 50 mg/dL or higher, CVD aHR was 1.31 (95% CI, 1.08-1.58).
  • The risk at that cutoff was slightly different for on-statin patients: aHR, 1.43 (95% CI, 1.15-1.76).
  • Very similar HRs with multivariate adjustment.
  • In fact, the on-statin risk was high vs on-placebo risk (Pinteraction=.010).
  • Risk also higher in younger age groups (P=.008).

Study design

  • Meta-analysis of patient-level data from 7 randomized, placebo-controlled trials of statins (n=29,069 in the analysis).
  • HRs calculated for cardiovascular events (nonfatal/fatal coronary heart disease, stroke, revascularization procedures).
  • Funding: Novartis Pharma AG.

Limitations

  • 35% of patients from included trials were excluded.
  • Some interstudy heterogeneity.

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