ASHP Midyear: Elevated Lp(a) Levels Pose Significant Cardiovascular Risk, Experts Emphasize Need for Awareness

Lp(a), or lipoprotein(a), is a causative factor for the development of atherosclerotic cardiovascular disease (ASCVD) that patients and providers need to take seriously. While current lipid-lowering therapies may provide some reduction in Lp(a) levels, these effects are generally insignificant and there are no FDA-approved treatments specifically for lowering Lp(a). Joseph Saseen, PharmD, professor and associate dean for clinical affairs at the University of Colorado Anschutz Medical Campus, emphasize that patients should know their Lp(a) levels, as elevated values significantly increase cardiovascular risk. Raising awareness and educating patients on the importance of Lp(a) is crucial, as many are unaware of this risk factor. Additionally, providers should be on the lookout for upcoming treatments that have demonstrated the ability to more robustly reduce Lp(a) and potentially lower cardiovascular event rates.

Pharmacy Times: How does Lp(a) contribute to atherosclerotic cardiovascular disease (ASCVD) risk?

Joseph Saseen: Lp(a), or we also call it LP little a, is a causative factor for the development of atherosclerotic cardiovascular disease [(ASCVD)], while we might not know exactly what it does, we know that that it's [low-density lioprotein (LDL)]-like and that patients with elevated Lp(a) values have an elevated risk of ASCVD, so we accept that it is a risk-enhancing factor and a causative factor to the development of ASCVD.

Pharmacy Times: How do statins and other LDL-C lowering therapies affect Lp(a) levels?

Joseph Saseen: We should basically look at our current lipid-lowering therapies as not effective Lp(a)-lowering treatments. No FDA indication covers lowering Lp(a). So while some of our LDL-lowering therapies may have a reduction, no effect or slight increase in Lp(a), I consider overall insignificant. The most robust reductions are seen with the PSK9 monoclonal antibodies or inhibitor which is inclisiran, but it's not enough to really probably make a big impact on reducing cardiovascular risk.

Pharmacy Times: What are the key points to emphasize when educating patients about Lp(a) and its role in CVD risk?

Joseph Saseen: Patients really need to know that Lp(a) should be measured in them. Period. It should be universally accepted as every patient should know what their Lp(a) level is at one point in their life. We can accept that it doesn't change much throughout their life, but knowing whether it's elevated is a risk-enhancing factor in themselves, and should trigger them to screen their relatives, or primary relatives for a similar type of elevation since it is inherited, and the basic bottom line is we should know to have it checked in ourselves and in our patients.

Pharmacy Times: How can pharmacists help patients understand the importance of medication adherence and lifestyle modifications?

Joseph Saseen: I think patients really need to be empowered with information, and we have to tailor to whatever their learning level is and their educational level is, but they need to know what's in it for them, why they should be on treatment, so that they can really buy into partnering up with their disease and their provider to actually treat their condition seriously. We have to motivate patients and find what is important to them, and I think with that proper information, they're more inclined to take their medicines. And then, as pharmacists, we need to make things easier and simplify regimens, determining the optimal treatment and the optimal doses for our patients.

Pharmacy Times: What are the most common barriers to medication adherence for patients with lipid disorders? How can pharmacists assess these barriers?

Joseph Saseen: Our treatments for lipid disorders fall into 2 buckets: cheap drugs and expensive drugs. The cheap drugs are actually very good, and the barrier there is patient acceptance and patient understanding of long-term risk and benefit. Often it's skewed with statins that patients under-realize the benefits while they over-realize the risks with our expensive drugs, which are add-ons to statins and other more traditional LDL-lowering therapies, probably the biggest barrier there is financial since these are expensive drugs that require prior authorization in certain criteria to be met for patients to be eligible to receive them under covered insurance.

Pharmacy Times: What are some common concerns or misconceptions that patients may have about Lp(a) and its treatment?

Joseph Saseen: There's probably not a lot of misconceptions. The biggest problem is people don't know anything about Lp(a). We know that 1 in 5 people in the United States have an elevated Lp(a) value. That there's some racial predictors of populations that may have higher Lp(a) values than others, and hence higher cardiovascular risk. But probably the biggest misconception is not really knowing and getting maybe it mixed up with other things we measure which predict cardiovascular risk.

Pharmacy Times: Is there anything else you would like to add?

Joseph Saseen: I guess number 1 is know what your Lp(a) is, number 2, know what your patient's Lp(a) value is, and number 3, be aware of treatments that are going to get approved most likely in the very near future, which, if they are approved, it's that they've been proven to reduce Lp(a) and reduce cardiovascular events.