Elevated Lipoprotein(a) Attenuates the Effect of Statin Therapy on Atherogenic Lipoproteins in Patients with Familial Hypercholesterolemia

Abstract

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Statin therapy increases lipo-protein(a) (Lp(a)), an important atherogenic lipoprotein that is an independent risk factor for cardiovascular disease. However, it is unclear if elevated Lp(a) attenuates the lipid lowering effect of statins on other atherogenic lipoproteins. Objective/Purpose To determine if the effects of statin therapy on the reduction of atherogenic lipoproteins is attenuated in familial hypercholesterolemia patients with elevated Lp(a). Methods This was a retrospective cohort study of 109 patients with familial hypercholesterolemia. The cohort was categorized into two groups based on Lp(a) with low risk defined as Lp(a) < 30mg/dL and high risk defined as Lp(a) ≥30mg/dL. The degree of reduction in fasting atherogenic lipoproteins (LDL-C, non-HDL-C and TC) was compared between both groups after initiation of statin therapy, using independent paired t-tests for continuous variables and Chi-square or Fisher's exact test as appropriate for categorical variables. Statistical analyses were performed using Microsoft Excel 2016 and PASW Statistics 18 software. Results A total of 109 patients with familial hypercholesterolemia (median age of 20, 49.5% females, 75.2% white) were included in the study. The low-risk group comprised 50.4% of the cohort and baseline characteristics were similar among both groups. There was a greater mean percent reduction of TC, LDL-C and non-HDL-C (35.2%, 43.6% and 42.0%) in the low-risk group compared to the high-risk group (27.5%, 35.9% and 32.7%) which was statistically significant (p-values <0.001). Conclusions Elevated Lp(a) mitigates the lipid lowering effects of statins on atherogenic lipoproteins in patients with FH and may signal residual cardiovascular risk unaddressed by statin therapy. These findings suggest that the presence of elevated Lp(a) in FH patients confers additional ASCVD risks due to compromised statin response. Nothing to disclose.