Conclusions Fibrates have a significantly greater effect in reducing plasma Lp(a ) concentrations than statins .
Addition of fibrates to statins can enhance the Lp(a)-lowering effect of statins
Background Raised plasma lipoprotein(a ) ( Lp(a ) ) concentration is an independent and causal risk factor for atherosclerotic cardiovascular disease .
Several types of pharmacological approaches are under evaluation for their potential to reduce plasma Lp(a ) levels .
There is suggestive evidence that statins and fibrates , two frequently employed lipid-lowering drugs , can lower plasma Lp(a ) .
The present study aims to compare the efficacy of fibrates and statins in reducing plasma concentrations of Lp(a ) using a meta- analysis of r and omized head-to-head trials .
l-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study
Lipoprotein ( a ) [ Lp(a ) ] is an independent risk factor for cardiovascular disease . There are currently limited therapeutic options to lower Lp(a ) levels . l-Carnitine has been reported to reduce Lp(a ) levels . The aim of this study was to compare the effect of l-carnitine/simvastatin co-administration with that of simvastatin monotherapy on Lp(a ) levels in subjects with mixed hyperlipidemia and elevated Lp(a ) concentration . Subjects with levels of low-density lipoprotein cholesterol ( LDL-C ) > 160 mg/dL , triacylglycerol ( TAG ) > 150 mg/dL and Lp(a ) > 20 mg/dL were included in this study . Subjects were r and omly allocated to receive l-carnitine 2 g/day plus simvastatin 20 mg/day ( N = 29 ) or placebo plus simvastatin 20 mg/day ( N = 29 ) for a total of 12 weeks . Lp(a ) was significantly reduced in the l-carnitine/simvastatin group [ −19.4 % , from 52 ( 20–171 ) to 42 ( 15–102 ) mg/dL ; p = 0.01 ] , but not in the placebo/simvastatin group [ −6.7 % , from 56 ( 26–108 ) to 52 ( 27–93 ) mg/dL , p = NS versus baseline and p = 0.016 for the comparison between groups ] . Similar significant reductions in total cholesterol , LDL-C , apolipoprotein ( apo ) B and TAG were observed in both groups . Co-administration of l-carnitine with simvastatin was associated with a significant , albeit modest , reduction in Lp(a )  compared with simvastatin monotherapy in subjects with mixed hyperlipidemia and elevated baseline Lp(a ) levels
Conclusions Fibrates have a significantly greater effect in reducing plasma Lp(a ) concentrations than statins .
Addition of fibrates to statins can enhance the Lp(a)-lowering effect of statins
Background Raised plasma lipoprotein(a ) ( Lp(a ) ) concentration is an independent and causal risk factor for atherosclerotic cardiovascular disease .
Several types of pharmacological approaches are under evaluation for their potential to reduce plasma Lp(a ) levels .
There is suggestive evidence that statins and fibrates , two frequently employed lipid-lowering drugs , can lower plasma Lp(a ) .
The present study aims to compare the efficacy of fibrates and statins in reducing plasma concentrations of Lp(a ) using a meta- analysis of r and omized head-to-head trials .