Effects of Statins Alone, or in Combination Therapy on Lipoprotein (A): A Single-Center Study

Background: There are little evidences about the therapeutic efficacy of different lipid-lowering agents in the reduction of elevated lipoprotein(a) [Lp(a)]. Objective: testing the effect of different lipid-lowering agents on elevated Lp(a).
Methods: prospective interventional study performed in patients with CAD, or high CAD risk, with Lp(a), >30 mg/dL. Lp(a), total cholesterol (C), HDL-C, LDL-C, triglycerides (TGs), apolipoprotein (Apo) A1, Apo B, enzymes of myocyte and hepatic injury were comparatively analyzed between 5 treatment
groups: Group 1: atorvastatin group (80mg/d); Group 2: rosuvastatin group (40mg/d); Group 3: atorvastatin switch on rosuvastatin group (80mg to 40mg/d); Group 4: atorvastatin add-on ERN (extended release niacin) (40 mg add-on 1 g); Group 5: atorvastatin add-on fibrate group (40 mg add-on 145mg micronized fenofibrate). Results: 132 patients with mean Lp(a) 91,4±40,3 mg/dL were analyzed. Groups: 1 - 29 patients; Group 2 - 26 pts.; Group 3 – 29 pts.; Group 4 – 24 pts. And Group 5 - 24 pts. Significant reduction in all lipid fractions in all treatment groups was reported after 6 months. The average reduction of Lp(a) was 14,15(15,5%) mg/dL, with: 24,45(25,3%) (P = 0.001) in the Group 3; 23,85(24,2%) (P = 0.001) in group 5; 20,01(19,6%) (P = 0.001) in Group 4 and the lowest in group 1- 7,04(6,9%) (P = 0.032). No adverse effects were observed in any of the treatment groups.
Conclusions: When compared with atorvastatin, it seems that rosuvastatin can achieve more significant decrease of Lp(a). The efficacy of the second one can be increased by adding fibrate or ERN.

Table 1. Comparative analysis of the therapeutic efficacy of different treatment strategies