What are the risks of elevated lipoprotein (a) and what drugs can be used?

Many friends asked Huazi what are the risks of elevated lipoprotein (a) (Lp(a)) and what drugs can be used to control it? Huazi's answer is that currently there are no drugs to control lipoprotein (a) on the market, so we can temporarily ignore this indicator and focus on controlling low-density lipoprotein cholesterol (LDL-C).

The lipid-lowering drugs currently used have poor control effects on lipoprotein (a) and have limitations. However, several drugs that use lipoprotein (a) as a therapeutic target are already undergoing phase III clinical trials. If all goes well, they may be available on the market within 1 to 2 years at the earliest.

What are the risks of elevated lipoprotein (a)?

Lipoprotein (a) is a special lipoprotein synthesized by the liver. It has a similar function to LDL-C and can also transport cholesterol to peripheral tissue cells. It also has a unique binding ability to blood vessels and promotes the deposition of lipids in the arterial intima . It is one of the risk factors for atherosclerosis.

Lipoprotein (a) may also inhibit the activation of plasminogen, putting the body in a procoagulant state. In other words, elevated lipoprotein (a) increases the risk of cardiovascular and cerebrovascular diseases .

However, the synthesis rate of lipoprotein (a) is greatly affected by genetic factors . The level of lipoprotein (a) is related to individual genes , and environmental factors such as diet and exercise have little effect on lipoprotein (a).

2. Limitations of current lipid-lowering drugs on lipoprotein (a)

Among the lipid-lowering drugs currently used, statins may slightly increase lipoprotein (a) levels, but statins are more effective in lowering LDL-C levels, so the benefits of taking statins far outweigh the risks.

Nicotinic acid lipid-lowering drugs have a lowering effect on lipoprotein (a), but in studies, they have not significantly reduced cardiovascular and cerebrovascular risks, and the drugs have many adverse reactions and no obvious benefits.

PCSK9 inhibitors can reduce LDL-C and lipoprotein (a) slightly. However, PCSK9 inhibitors are mainly used for patients with elevated LDL-C and are not recommended for patients with elevated lipoprotein (a).

3. Drugs targeting lipoprotein (a) are still under development

Drugs targeting lipoprotein (a) targets, mainly antisense oligonucleotide (ASO) drugs and small interfering RNA (siRNA) drugs such as Pelacarsen, Lepodisiran, and MK-0616, have now entered Phase III clinical trials. If the trials are successful, it is possible to submit marketing applications in the United States and the European Union in 2025-2026 .

Imported drugs need approval before they can be marketed in China, which usually takes about a year.

There are also domestic pharmaceutical companies planning to develop drugs targeting lipoprotein (a), but they have not yet entered the third phase of clinical trials and may be launched on the market later.

IV. What to do if there is no available medicine now?

Because there is no drug available now and the drug development process is full of uncertainty, Huazi’s advice to friends is to temporarily ignore lipoprotein (a) and focus the treatment on controlling LDL-C .

Through healthy living and rational use of drugs, we can control LDL-C at a low level and minimize the risk of cardiovascular and cerebrovascular diseases. We can wait until new drugs are available before conducting targeted treatment.

Human resources may be limited, but technology will continue to advance. We must make the most of what we have now and strive to live longer and healthier so that we can enjoy a better future.

In summary, elevated lipoprotein (a) increases the risk of cardiovascular and cerebrovascular diseases, but there are currently no suitable drugs available, and it will take some time for the relevant drugs to be available on the market. Therefore, we can ignore the lipoprotein (a) indicator for now and focus on controlling the LDL-C level.

If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.