Lipoprotein (a) and lipid-lowering treatment from the perspective of a cardiac surgeon. An impact on the prognosis in patients with aortic valve replacement and after heart transplantation

Abstract

Lipoprotein(a) is a recognized risk factor for ASCVD. There is still no targeted therapy for Lp(a), however, drugs such as pelacarsen, olpasiran, zerlasiran, lepodisiran and muvalaplin are in clinical trials and have been shown to be effective in significantly reducing Lp(a) levels. Moreover, elevated Lp(a) levels significantly affect the prognosis of patients after aortic valve replacement (AVR) and heart transplantation (HTx). Therefore, the assessment of Lp(a) concentration in these patients will allow for a more accurate stratification of their cardiovascular risk, and the possibility of lowering Lp(a) will allow for the optimization of this risk. In this article, we summarized the most important information regarding the role of Lp(a) and lipid-lowering treatment in patients after AVR and HTx.

Keywords: Aortic stenosis; Aortic valve replacement; Cardiovascular risk optimization; Heart transplantation; Lipoprotein (a).

Fig. 1

The role of lipoprotein (a) and lipid-lowering treatment in patients after AVR or HTx. Based on information from Refs. [[1], [2], [3], [4], [5],[14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26],[32], [33], [34], [35], [36], [37],[44], [45], [46], [47], [48], [49], [50]]. The elements of the figure were created using SERVIER MEDICAL ART (CC BY 4.0). CAV photos used from: Das B.B. et al. Transplantology 2022; 3(3): 241–256 - CC BY license - no permission required. Other photos used are the property of the authors - no permission required. Details about Lp(a)-targeted drugs in the text of the article. Abbreviations: Lp(a) – lipoprotein (a); AS – aortic stenosis; HR – hazard ratio; TAVI - transcatheter aortic valve implantation; AVR – aortic valve replacement; MACE – major adverse cardiovascular event; SAVR – surgical aortic valve replacement; ASCVD – atherosclerotic cardiovascular disease; PCSK9 - proprotein convertase subtilisin-kexin type 9; Apo(a) – apolipoprotein (a); LDL – low-density lipoprotein; ApoB₁₀₀ – apolipoprotein B₁₀₀; oxPL - oxidized phospholipids; Lp-PLA2 - lipoprotein‐associated phospholipase A2; HFpEF – heart failure with preserved ejection fraction; HFrEF – heart failure with reduced ejection fraction; HTx - heart transplantation; CAV - cardiac allograft vasculopathy.