Lp(a) and cardiovascular events: which test is the best?

Mass spectrometry lipoprotein (a) (Lp[a]) assessment and immunoassay-based Lp(a) tests were equally prognostic for major adverse cardiovascular events (MACE) in patients with recent acute coronary syndrome (ACS) receiving placebo in the ODYSSEY OUTCOMES study. Furthermore, the tests performed similarly in terms of predicting MACE reductions in the active arm of the study, in which patients received the PCSK9 inhibitor alirocumab.

CO, USA) explained that Lp(a) is a well-known risk factor for cardiovascular events and that it hampers the responsiveness to PCSK9 inhibitors [1]. However, it is not yet clear which Lp(a) assessment should be used to map these prognostic and predictive associations. In the phase 3 ODYSSEY OUTCOMES study (NCT01663402), patients with recent ACS (n=11,970) were randomised to treatment with the PCSK9 inhibitor alirocumab or placebo. In addition, baseline Lp(a) was measured by 3 different tests:

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  • Siemens N-latex nephelometric immunoassay (IA-mass; mg/dL)
  • Roche TinaQuant turbidimetric immunoassay (IA-molar; nmol/L)
  • semi-automated mass spectrometry (MS; mmol/L)

The investigators observed the value of these assessments for the prognosis of MACE in the placebo group and the prediction of MACE reductions in the alirocumab arm.

In the placebo arm, the associations of Lp(a) concentrations and MACE risk were nearly identical for the 3 different tests, implying that the different methods of measurement were equally precise for the prognostication of MACE (see Figure). Likewise, the 3 tests were similar in predicting MACE reductions following alirocumab therapy.

These data suggest that Lp(a) is an important risk predictor regardless of how measured and may enable easier application in broad populations.

Figure: Prognosis of MACE according to Lp(a) concentrations in placebo arm [1]

University of Colorado, ODYSSEY OUTCOMES

MACE, major adverse cardiovascular events; MS, mass spectrometry.

1. 
   
   1. Szarek M, et al. Two of a kind: mass and molar immunoassay-based lipoprotein (a) concentrations are similarly prognostic for MACE risk and predictive of alirocumab benefit in ODYSSEY OUTCOMES. ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.

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Posted on 30 October, 202330 October, 2023