Study on Lipoprotein(a) and Cardiovascular Events

Among patients receiving intensive statin therapy following a recent acute coronary syndrome, patient-level reductions in lipoprotein(a) by alirocumab independently contributed to reduced risk of a first primary outcome event and first PAD or VTE event, suggests the reports of a recently published study in the European Heart Journal.

In previous studies, elevated baseline levels of lipoprotein(a), a genetically determined low-density lipoprotein particle, have been associated with increased risk of cardiovascular events.

Lipoprotein(a) concentration is associated with first cardiovascular events in clinical trials. It is unknown if this relationship holds for total (first and subsequent) events.

In the ODYSSEY OUTCOMES trial in patients with recent acute coronary syndrome (ACS), researchers assessed the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab reduced lipoprotein(a), low-density lipoprotein cholesterol (LDL-C), and cardiovascular events, compared with placebo. The trial continued until 1613 patients experienced a primary outcome event or all surviving patients (other than those enrolled in China) were eligible to be followed for at least 2 years.

The outcomes assessed were cardiovascular events including:

• Cardiovascular death
• Non-fatal myocardial infarction
• Stroke
• Hospitalization for unstable angina or heart failure
• Ischaemia-driven coronary revascularization
• Peripheral artery disease events
• Venous thromboembolism

Proportional hazards models estimated relationships between baseline lipoprotein(a) and total cardiovascular events in the placebo group, effects of alirocumab treatment on total cardiovascular events by baseline lipoprotein(a), and relationships between lipoprotein(a) reduction with alirocumab and subsequent risk of total cardiovascular events.

Key Findings

• Baseline lipoprotein(a) predicted total cardiovascular events with placebo, while higher baseline lipoprotein(a) levels were associated with greater reduction in total cardiovascular events with alirocumab (hazard ratio Ptrend = 0.045).
• Alirocumab-induced reductions in lipoprotein(a) (median -5.0 [-13.6, 0] mg/dL) and corrected LDL-C (median -51.3 [-67.1, -34.0] mg/dL) independently predicted lower risk of total cardiovascular events.
• Each 5-mg/dL reduction in lipoprotein(a) predicted a 2.5% relative reduction in cardiovascular events.

"These findings support the concept of lipoprotein(a) as a treatment target among high-risk patients with a recent acute coronary syndrome," wrote the team.

Primary source: European Heart Journal

For the full article, follow the link: doi:10.1093/eurheartj/ehaa649