I suspect many of my non-physician followers will be confused, so this needs a response. I think we agree that risk rises with higher Lp(a). I do agree if ones Lp(a) is 50 risk is low. I don't agree that saying a risk of >50 mg/dL is either trivial or a slogan.
I think a 20% higher risk (going from a 10% risk of dying, having a heart attack or stroke) to 8% (over 3 years only like in the trial, not a lifetime of 40-80 years!!) is significant to those whose own Lp(a) is elevated, needed one or more procedures or lost a loved one.
This 20% risk in 3 years in a trial will add up substantially as the years go on and curves will continue to separate relative to low Lp(a) patients. We have to look at lifetime risk, not what risk is in a short term trial. The 10 vs 8% could end up being 50% vs 30% in 20 years.
Novartis is enrolling subjects with Lp(a) >70 mg/dL, so this is 1 in 6. The mean Lp(a) in this trial is expected to be ~90, and these subjects will already had an event. We will know if this was a wise choice in 2024-5. Patientss want to be treated before an event, not after.
My main goal for the 2 decades in pushing the Lp(a) story is not scare people or over hype the risk, but to raise awareness and to bring a potential therapy to those in highest risk. I feel that Lp(a) should be part of the first lipid panel, and everyone should know their level.
All physicians and patients should be aware of this risk factor (but a vast minority are right now, <5%), just like we would agree with LDL-C.
