Low Lipoprotein(a) Levels Linked to Higher Diabetes Risk

An analysis from the FOURIER trial found that among patients with established atherosclerotic cardiovascular disease, lower lipoprotein(a) [Lp(a)] concentrations were associated with a higher prevalence of diabetes at baseline and a greater risk of developing diabetes during follow-up, while showing no increased risk of most other major adverse safety outcomes. Researchers evaluated 25,090 participants with a median Lp(a) level of 37 nmol/L and found that lower Lp(a) was independently associated with both existing and new-onset diabetes, with diabetes risk increasing with reduction in Lp(a). Importantly, low Lp(a) was not linked to higher rates of hemorrhagic stroke, serious bleeding, neurocognitive events, cancer, or atrial fibrillation, even among individuals with very low Lp(a) levels (≤13 nmol/L). The study also examined the PCSK9 inhibitor evolocumab, which substantially lowers Lp(a), and found that it did not increase diabetes risk regardless of baseline Lp(a) concentration, including in patients who experienced the largest reductions in Lp(a). These findings suggest that while naturally low Lp(a) levels may be associated with a greater risk of diabetes, pharmacologic lowering of Lp(a) with evolocumab does not appear to worsen diabetes risk, providing reassuring safety data. Source: https://academic.oup.com/eurheartj/