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 .
Lipoprotein(a), measured with an assay independent of apolipoprotein(a) isoform size, and risk of future cardiovascular events among initially healthy women.
CONTEXT Controversy exists as to whether lipoprotein(a ) , a lipoprotein with homology to plasminogen , is a clinical ly meaningful cardiovascular risk marker in women . There is also poor agreement among lipoprotein(a ) levels obtained by different assays . OBJECTIVE To determine the association of  lipoprotein(a ) levels , measured with an assay independent of apolipoprotein(a ) isoform size , with the incidence of future cardiovascular events . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve study of 27,791 initially healthy women in the Women 's Health Study , enrolled between November 1992 and July 1995 and followed up for 10 years .  Lipoprotein(a ) level  was measured in blood sample s obtained at baseline with an assay independent of apolipoprotein(a ) isoform size . MAIN OUTCOME MEASURE Hazard ratios ( HRs ) for first-ever major cardiovascular events ( nonfatal myocardial infa rct ion , nonfatal cerebrovascular event , coronary revascularization , or cardiovascular deaths ) . RESULTS During follow-up , there were 899 incident cardiovascular events . After adjusting for age , smoking , blood pressure , body mass index , total cholesterol , high-density lipoprotein cholesterol , diabetes , hormone use , C-reactive protein , and r and omization treatment groups , women in the highest quintile of lipoprotein(a ) ( > or = 44.0 mg/dL ) were 1.47 times more likely ( 95 % CI , 1.21 - 1.79 ; P for trend < .001 ) to develop cardiovascular events than women in the lowest quintile ( < or = 3.4 mg/dL ) . This association , however , was due almost entirely to a threshold effect among those with the highest lipoprotein(a ) levels . After adjusting for all of the variables listed above , the HR associated with lipoprotein(a ) levels exceeding the 90th percentile ( > or = 65.5 mg/dL ) was 1.66 ( 95 % CI , 1.38 - 1.99 ) ; 95th percentile ( > or = 83 mg/dL ) , 1.87 ( 95 % CI , 1.50 - 2.34 ) ; and 99th percentile ( > or = 130.7 mg/dL ) , 1.99 ( 95 % CI , 1.32 - 3.00 ) , with almost no risk gradient at lower levels . Associations were strongest among women with low-density lipoprotein cholesterol ( LDL-C ) above the median level . In this subgroup , the adjusted HR associated with lipoprotein(a ) levels exceeding the 90th percentile was 1.81 ( 95 % CI , 1.48 - 2.23 ) ; 95th percentile , 1.93 ( 95 % CI , 1.51 - 2.48 ) ; and 99th percentile , 1.93 ( 95 % CI , 1.21 - 3.05 ) ( P value for interaction with LDL-C = .001 ) . CONCLUSIONS In this cohort of initially healthy women , extremely high levels of lipoprotein(a ) ( > or = 90th percentile ) , measured with an assay independent of apolipoprotein(a ) isoform size , were associated with increased cardiovascular risk , particularly in women with high levels of LDL-C. However , the threshold and interaction effects observed do not support routine measurement of lipoprotein(a ) for cardiovascular stratification in women
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 .