Table 1_Lipoprotein(a) in the statin era: from risk marker to therapeutic target.pdf

Real-world screening rates also remain very low, despite a guideline consensus on once-in-a-lifetime testing. This picture is now changing rapidly. RNA-targeted agents, comprising antisense oligonucleotides and small interfering RNAs, together with a first oral small-molecule inhibitor, lower Lp(a) by about 65% to more than 95%, differing in mechanism, route of administration, dosing interval and durability.

Two questions remain open: how large an absolute reduction is needed for clinical benefit (the threshold hypothesis), and whether lowering Lp(a) reduces major adverse cardiovascular events at all. Several cardiovascular outcomes trials are now testing these questions directly. They include Lp(a)HORIZON, OCEAN(a)-Outcomes, and ACCLAIM-Lp(a), together with a dedicated aortic-valve trial, and the first readouts are anticipated.

Framing Lp(a) as the residual cardiovascular risk target of the statin era, this review integrates measurement, screening, risk stratification, current management, and emerging targeted therapies into a single clinical and pharmacological roadmap for the outcomes-trial era.</p>