Lipoprotein (a)

Lipoprotein (a) is a variant of LDL particle and has in addition to apolipoprotein B, apolipoprotein (a). It is a strong independent risk factor for premature coronary artery disease. Atherogenicity of Lipoprotein (a) is higher than that of LDL cholesterol. It has been even called as a low density lipoprotein particle “on steroids”. Lipoprotein (a) is highly thrombogenic and antifibrinolytic, by virtue of its homology to plasminogen molecule.

Lipoprotein (a) levels are genetically determined with environmental factors having only a negligible impact. Childhood levels of Lipoprotein (a) are a better predictor and marker for future coronary artery disease in young adult life than any other lipoproteins.

Of great interest are two ongoing clinical trials of Lipoprotein (a) lowering medications. Lp(a)HORIZON is evaluating Pelacarsen (NCT04023552) and is expected to be completed by 2025. OCEAN(a) is evaluating Olpasiran (NCT05581303) and expected completion is in 2026.