The time for lipoprotein(a) based intervention has arrived: where will the light shine?
For more than a quarter century, evidence has accumulated supporting the pivotal role of lowering levels of low-density lipoprotein cholesterol (LDL-C). The benefits of more intensive lipid lowering have been reflected in treatment guidelines and increasing use of high intensity statin therapy in patients at the highest risk of experiencing a cardiovascular event. In more recent years, we have observed incremental benefit from use of additional lipid lowering agents, beyond statins, which have further consolidated the LDL hypothesis in atherosclerotic cardiovascular disease. Yet, there remains a substantial residual risk of cardiovascular events, despite use of these agents and achieving lower LDL-C levels. This suggests that modifying additional targets may be required to achieve more effective reductions in cardiovascular risk.