Lowering of lipoprotein(a) level under niacin treatment is dependent on apolipoprotein(a) phenotype

• Published in: Atherosclerosis. Supplements Vol. 18; pp. 53 - 58
• Main Authors: Artemeva, N.V., Safarova, M.S., Ezhov, M.V., Afanasieva, O.I., Dmitrieva, O.A., Pokrovsky, S.N.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 01.05.2015
• Subjects: Adult; Apolipoprotein(a) phenotype; Apoprotein(a) - blood; Biomarkers - blood; Down-Regulation; Humans; Hyperlipoproteinemias - blood; Hyperlipoproteinemias - diagnosis; Hyperlipoproteinemias - drug therapy; Hypolipidemic Agents - therapeutic use; Lipoprotein(a); Lipoprotein(a) - blood; Male; Middle Aged; Molecular Weight; Niacin; Niacin - therapeutic use; Patient Selection; Phenotype; Predictive Value of Tests; Prospective Studies; Russia; Time Factors; Treatment Outcome; Russia; Apolipoprotein(a) phenotype; Niacin; Lipoprotein(a)
• ISSN: 1567-5688; 1878-5050; 1878-5050
• DOI: 10.1016/j.atherosclerosissup.2015.02.008

Lipoprotein(a) [Lp(a)] is a cardiovascular risk factor; in addition to being a low-density lipoprotein (LDL)-like particle, it contains highly heterogeneous apolipoprotein(a) [apo(a)]. No prior studies have evaluated extended-release (ER) niacin effect on Lp(a) level depending on apo(a) phenotype. For this 24-week, prospective, open-label clinical trial we recruited 30 men (mean age 46.2 ± 7.5 years) with Lp(a) levels >20 mg/dL. No participant had previously received lipid lowering therapy, and started ER niacin 500 mg with stepwise dose increasing up to 1.5–2.0 g. Subjects were evaluated for Lp(a), lipids, high-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2 (Lp-PLA2), and fibrinolytic markers (plasminogen activator inhibitor-1, tissue plasminogen activator/plasminogen activator inhibitor-1 complex, plasmin–antiplasmin complex). Patients were divided into two groups with major low- (LMW) or high-molecular weight (HMW) apo(a) isoforms determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of plasma under reducing conditions followed by immunoblotting. At baseline, groups were comparable in age, lipid, inflammatory and fibrinolytic biomarkers levels. There was a significant difference in baseline Lp(a) concentrations: 92 ± 29 mg/dL versus 54 ± 46 mg/dL in LMW and HMW apo(a) groups, respectively, p < 0.01. During the course of niacin treatment Lp(a) decreased by 28% (p < 0.003), Lp-PLA2 by 22% (p < 0.001), C-reactive protein by 24% (p = 0.07) in LMW apo(a) group, whereas no changes in Lp(a) and biomarkers levels were obtained in HMW apo(a) group. High-dose ER niacin declines elevated Lp(a) level in male subjects with low- but not high-molecular weight apo(a) phenotype.