William Cromwell, MD

Whether statins meaningfully increase Lp(a) has been the topic of spirited discussion. Last year, de Boer LM et al. published a comprehensive review and meta-analysis of the effect of statins compared to placebo on Lp(a) in the European Journal of Preventive Cardiology. Their conclusion, “Statin therapy does not lead to clinically important differences in Lp(a) compared to placebo in patients at risk for CVD. Our findings suggest that in these patients, statin therapy will not change Lp(a)-associated CVD risk.”

Thanks for your feedback. The first step in addressing high LDL is seeking to understand. How high is the LDL? How long has high LDL been present? What comorbid factors are contributing to high LDL? Is this likely familial hypercholesterolemia? Does the individual have known subclinical or clinical ASCVD? What workup has been performed? What risk-enhancing factors are present? These and other factors contribute to my recommendations.