Lipoprotein (a) is a causal genetic risk factor for atherosclerotic cardiovascular disease. But it remains unclear which patients with underlying atherosclerotic cardiovascular disease tend to benefit the most from the Lp(a) lowering. The objective of this research was to examine if system inflammation in treated patients with a higher risk of CV disease inflects the Lp(a)-associated CV risk.

The trial was conducted between October 1, 2012, and December 31, 2013, and the study was terminated on October 12, 2015. The research setting included 543 academic and community hospitals in 36 countries, with 12,092 patients at the right risk of CV disease. The trial was named ACCELERATE (Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib in Patients at a High Risk for Vascular Outcomes). All the participants received evacetrapib 130 mg/d or a similar placebo.

The trial found no considerable benefit or harm of evacetrapib on major cardiovascular events in the 30-month trial period. However, high-sensitivity C-reactive protein and Lp(a) levels were found in 10,503 patients. Besides, each unit increase in log Lp(a) levels resulted in a 13% increased risk of CV death, stroke, or non-fatal MI, when the hsCRP levels are higher than or equal to 2mg/L.

The research concluded that elevated levels of Lp(a) during the treatment are linked with a higher risk of CV death, stroke, and MI when hsCRP levels are 2mg/L or more. It suggests a clear benefit of lowering Lp(a) levels in patients with residual systemic inflammation.

Ref: https://jamanetwork.com/journals/jamacardiology/fullarticle/2768166