Emerging RNA Therapeutics to Lower Blood Levels of Lp(a) JACC Focus Seminar 2/4

Lipoprotein(a) [Lp(a)] has risen to the level of an accepted cardiovascular disease risk factor, but final proof of causality awaits a randomized trial of Lp(a) towering. Inhibiting apotipoprotein(a) production in the hepatocyte with ribonucleic add therapeutics has emerged as an elegant and effective solution to reduce plasma Lp(a) levels. Phase 2 clinical trials have shown that the antisense oligonucleotide petacarsen reduced mean Lp(a) levels by 80%, allowing 98% of subjects to reach on-treatment levels of <125 nmol/l (similar to 50 mg/dl). The phase 3 Lp(a)HORIZON (Assessing the Impact of Lipo-protein(a) Lowering With TQJ230 on Major Cardiovascular Events in Patients With CVD) outcomes trial is currently enrolling approximately 7,680 patients with history of myocardial infarction, ischemic stroke, and symptomatic peripheral arterial disease and controlled tow-density lipoprotein cholesterol to petacarsen versus placebo. The co-primary endpoints are major adverse cardiovascular events in subjects with Lp(a) >70 mg/dl and >90 mg/dl, in which either of the two being positive will lead to a successful trial. Additional ribonucleic acid-targeted therapies to tower Lp(a) are in preclinical and clinical development. The testing of the Lp(a) hypothesis will provide proof whether Lp(a)-mediated risk can be abolished by potent Lp(a) lowering. (C) 2021 by the American College of Cardiology Foundation.

Automated summary

Lipoprotein(a) [Lp(a)] has been recognized as a cardiovascular disease risk factor, and new therapies are being developed to effectively reduce its levels, with ongoing clinical trials to further evaluate their effectiveness. The testing of new Lp(a)-targeted therapies will provide evidence on whether lowering Lp(a) levels can eliminate associated risks.