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Absolute reduction in Lp(a) concentration lowers CHD risk
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A reduction of lipoprotein(a) and an absolute reduction in Lp(a) concentration had a proportional clinical benefit, according to an analysis published in JAMA Cardiology.
“The results of this study may have important implications for informing clinical practice guidelines on the use of Lp(a)-lowering therapies, for designing randomized trials to evaluate Lp(a)-lowering therapies currently in development and for designing screening programs to reduce the global burden of CHD,” Stephen Burgess, PhD, Sir Henry Welcome Post-doctoral Fellow in the department of public health and primary care at University of Cambridge School of Clinical Medicine in the United Kingdom, and colleagues wrote.
Mendelian randomization analysis
In a mendelian randomization analysis, the researchers analyzed data from 20,793 patients with CHD and 27,540 without CHD from five studies.
The primary outcome was CHD, defined as nonfatal MI or CHD death. In three of the studies, CHD included other coronary events.
All patients underwent genotyping, which was used to calculate a weighted genetic score. The score was then used to categorize patients into deciles.
Researchers also analyzed data from 62,240 patients and 127,299 controls to assess genetic associations with CHD risk.
Of the participants included in the study, 53% were men and the mean age was 58 years.
The link between genetically predicted Lp(a) with the risk for CHD was linearly proportional to the absolute change in the concentration of Lp(a).
Each 10-mg/dL decrease of genetically predicted Lp(a) was linked to a 5.8% decreased risk for CHD (OR = 0.942; 95% CI, 0.933-0.951). This same reduction of genetically predicted LDL, which was estimated by an LDL genetic score, was linked to a 14.5% decrease in CHD risk (OR = 0.855; 95% CI, 0.818-0.893). A change in Lp(a) concentration of 101.5 mg/dL (95% CI, 71-137) was similarly associated with the risk for CHD as a 38.67-mg/dL change in LDL.
Similar associations
The association between genetically predicted Lp(a) concentration and CHD risk was independent of changes in LDL caused by genetic variants that have similar relationships as PCSK9 inhibitors, statins and ezetimibe.
“Screening for individuals with extremely elevated Lp(a) concentrations and treating them with one of the new Lp(a)-lowering therapies in development could potentially have the same effect on reducing the global burden of CHD as current screening programs designed to detect and treat individuals with familial hypercholesterolemia,” Burgess and colleagues wrote.
“At present, these data may be viewed as a stronger level of observational data,” Christopher J. O’Donnell, MD, MPH, associate professor of medicine at Brigham and Women’s Hospital, wrote in a related editor’s note. “While [mendelian randomization] studies may lend support or cast doubt on whether an observational association may infer causality, data from human-randomized clinical trials remain the strongest level of evidence for clinical practice. Nevertheless, the opportunity to harness [mendelian randomization] data for all types of precision medicine questions will certainly increase as immense samples of populations with deep genomic data become available from biobanks, such as the UK Biobank and the VA Million Veteran Program.” – by Darlene Dobkowski
Disclosures: Burgess and O’Donnell report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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