Niacin/Laropiprant therapy reduces serum Lipoprotein (a) levels

Background. High plasma levels of lipoprotein(a) [Lp(a)] are risk factor for ischemic heart disease, stroke and are associated with the severity of coronary atherosclerosis. We sought to see whether extended-release niacin/laropiprant (ERN/LRPN) could lower Lp(a) levels. Material and Methods. We followed-up for 8 weeks a group of 16 patients (mean age 55±12 years, 66% male) with high Lp(a) levels and chronic coronary artery disease. ERN/LRPN was added on top of maximally tolerated lipid-lowering therapy, administered at the dose of 1 gr/day for the first 4 weeks and then at 2 gr/day for the remaining period. Clinical examination and blood sampling (including lipid profile, renal and hepatic function) were performed at baseline, after 4 and 8 weeks, and in the case of adverse manifestations. Results. During follow-up, 4 patients discontinued therapy due to side effects (headache, asthenia, and gastrointestinal disorders in 2 patients, eruptive skin rash in 1 patient, onset of diabetes mellitus in 1 patient). In the remaining 12 patients, a significant reduction of Lp(a) serum concentrations was observed: Lp(a) levels was reduced of 20.6% after 4 week (p<0.0005) and of 36.0% after 8 week (p<0.005) respect to basal serum concentrations. After two months of therapy, in 36% of patients Lp(a) values were normalized (i.e <60 mg/dl). These results are obtained in the absence of substantial changes in other laboratory analyses (with the exception of a non-significant increase in uric acid). Conclusions. These results show that the ERN/LRPN therapy significant reduces Lp(a) levels, thus representing a new treatment option in patients with high Lp(a) levels and coronary artery disease, although the high frequency of collateral effects may be a limitation.