title: Lipoprotein(a): novel target and emergence of novel therapies to lower cardiovascular disease risk.
abstract: OBJECTIVE
  This article summarizes recent observations on the role of lipoprotein(a) [Lp(a)] as a risk factor mediating cardiovascular disease.
  
  
  RESULTS
  Lp(a) is a highly prevalent cardiovascular risk factor, with levels above 30 mg/dl affecting 20-30% of the global population. Up until now, no specific therapies have been developed to lower Lp(a) levels. Three major levels of evidence support the notion that elevated Lp(a) levels are a causal, independent, genetic risk factor for cardiovascular disease: epidemiologic studies and meta-analyses, genome-wide association studies and Mendelian randomization studies. Recent studies also have noted that individuals with low levels of Lp(a) are associated with a higher risk of incident type 2 diabetes mellitus, and conversely individuals with high levels have a lower risk, but this association does not appear to be causal. Novel therapies to lower Lp(a) include PCSK9 inhibitors and antisense oligonucleotides directly preventing translation of apolipoprotein(a) mRNA.
  
  
  CONCLUSIONS
  With this robust and expanding clinical database, a reawakening of interest in Lp(a) as clinical risk factor is taking place. Trials are underway with novel drugs that substantially lower Lp(a) and may reduce its contribution to cardiovascular disease.
authors.affiliation: Vascular Medicine Program, Sulpizio Cardiovascular Center, University of California San Diego School of Medicine, La Jolla, California, USA.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsimikas
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015536:Down-Regulation; D055808:Drug Discovery; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D017270:Lipoprotein(a) / Q000097:blood* / Q000235:genetics; D058990:Molecular Targeted Therapy; D016376:Oligonucleotides, Antisense / Q000627:therapeutic use; D000091362:PCSK9 Inhibitors; D000071449:Proprotein Convertase 9 / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D017270:Lipoprotein(a); D016376:Oligonucleotides, Antisense; D000091362:PCSK9 Inhibitors; D015842:Serine Proteinase Inhibitors; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
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