The Role of Lipoprotein (a) as a Marker of Residual Risk in Patients With Diabetes and Established Cardiovascular Disease on Optimal Medical Therapy: Post-Hoc Analysis of ACCELERATE

Despite optimal medical treatment, patients with diabetes and established atherosclerotic disease remain at high risk for recurrent cardiovascular events. Consequently, identification and modification of novel risk factors that mediate residual risk remain an important clinical priority. Lipoprotein (a) [Lp(a)] is an LDL-like particle in which apolipoprotein B is covalently bound by a single disulfide bond to apolipoprotein A, and it has both thrombotic and proinflammatory characteristics (1). There is also a growing body of evidence showing causality of atherosclerotic disease with elevated Lp(a) (1). However, little is known about the predictive role of Lp(a) in patients with diabetes and established cardiovascular disease receiving optimal medical treatment. Thus, given that Lp(a) is an established marker of cardiovascular disease with targeted therapies currently in clinical trials (NCT03070782, ClinicalTrials.gov), we sought to see the impact of elevated Lp(a) in a high-risk secondary prevention cohort of patients with diabetes on optimal medical treatment enrolled in the Assessment of Clinical Effects of Cholesteryl Ester Transfer Protein Inhibition With Evacetrapib in Patients at a High Risk for Vascular Outcomes (ACCELERATE) trial to identify patients who could potentially benefit from Lp(a)-targeted treatment (2). In our post hoc analysis, participants who met eligibility to enroll in the trial were divided into patients with and without diabetes to assess the impact of Lp(a) tertiles in each group. Baseline Lp(a) levels (in nmol/L) were measured by a central laboratory, using the …