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 .
Reduction in lipoprotein(a) with PCSK9 monoclonal antibody evolocumab (AMG 145): a pooled analysis of more than 1,300 patients in 4 phase II trials.
OBJECTIVES The purpose of this study was assess the effect of  evolocumab  (  AMG 145 ) on lipoprotein (Lp)(a ) from a pooled analysis of 4 phase II trials . BACKGROUND Lp(a ) , a low-density lipoprotein ( LDL ) particle linked to the plasminogen-like glycoprotein apolipoprotein(a ) , shows a consistent and independent positive association with cardiovascular disease risk in epidemiological studies . Current therapeutic options to reduce Lp(a ) are limited . METHODS A pooled analysis of data from 1,359 patients in 4 phase II trials assessed the effects of  evolocumab  , a fully human monoclonal antibody to PCSK9 , on Lp(a ) , the relationship between Lp(a ) and lowering of low-density lipoprotein cholesterol ( LDL-C ) and apolipoprotein B , and the influence of background statin therapy . Lp(a ) was measured using a st and ardized isoform-independent method . RESULTS Evolocumab treatment for 12 weeks result ed in significant ( p < 0.001 ) mean ( 95 % confidence interval ) dose-related reductions in Lp(a ) compared to control : 29.5 % ( 23.3 % to 35.7 % ) and 24.5 % ( 20.4 % to 28.7 % ) with 140 mg and 420 mg , dosed every 2 and 4 weeks , respectively , with no plateau of effect . Lp(a ) reductions were significantly correlated with percentages of reductions in LDL-C ( Spearman correlation coefficient , 0.5134 ; p < 0.001 ) and apolipoprotein B ( Spearman correlation coefficient , 0.5203 ; p < 0 . 001 ) . Mean percentage reductions did not differ based on age or sex but the trend was greater in those patients taking statins . CONCLUSIONS Inhibition of PCSK9 with evolocumab result ed in significant dose-related reductions in Lp(a ) . While the mean percentage of reduction was significantly greater in those patients with baseline Lp(a ) of ≤125 nmol/l , the absolute reduction was substantially larger in those with levels > 125 nmol/l
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 .