Davide Capodanno: Lp(a) After HORIZON and the Outcome Question
Davide Capodanno, Professor of Cardiology at University of Catania, shared a post on X:
”The day after the announcement of the neutral results of HORIZON Lp(a), and while keeping in mind that nobody has yet seen the final results (although, in practical and regulatory terms, that may matter little), much of the discussion is focusing on Lp(a) as a prognostic risk-stratification marker.
The argument goes: ‘If you, as a patient, have high Lp(a), then you are a high-risk patient, and I will intensify the therapies I have available’—starting from the assumption that, without knowing your Lp(a), I would somehow not have done so based on other available biomarkers and clinical features. But this raises at least two other questions.
First: what therapy has evidence specifically in patients with elevated Lp(a)?
Are there trials of non-Lp(a)-lowering drugs conducted specifically in patients with elevated Lp(a) (all patients, not just a subgroup—no cheating)?
Second: if universal Lp(a) screening is indeed useful even though we have no evidence that lowering Lp(a) improves outcomes, are there at least studies showing that knowing the Lp(a) level improves outcomes?
In other words, are there trials in which physicians—not patients—are randomized to know versus not know the Lp(a) value, and therefore to act accordingly (e.g., prescribing exercise or other therapies that physicians in the control group would presumably consider anyway)?”
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