PCSK9 inhibition
Adding PCSK9 inhibitors to niacin further lowers Lp(a) by about 15%, a retrospective analysis of 150 patients (J Clin Lipidol 2019)
Original title: Impact of PCSK9 inhibitors on plasma lipoprotein(a) concentrations with or without a background of niacin therapy
This retrospective analysis examined whether adding PCSK9 inhibitors (PCSK9i) to background niacin therapy further lowers Lp(a), comparing 136 patients on PCSK9i monotherapy with 14 on niacin plus PCSK9i combination therapy. In the combination group, median Lp(a) fell by 15.3% (interquartile range -31.8 to -1) and 9 mg/dL (IQR -37.2 to -0.5) from a baseline of 95 mg/dL (IQR 20.5-171), reductions that were statistically significant or nearly so (P=.04 and P=.05). In the monotherapy group, median Lp(a) fell by 17.3% (IQR -34.4 to 0) and 6 mg/dL (IQR -16 to 0) from a baseline of 39.5 mg/dL (IQR 15-117.5), with no significant difference in percent or absolute change between the monotherapy and combination groups (P=.84 and P=.54). The findings show adding PCSK9i to background niacin therapy is associated with approximately 15% additional Lp(a) reduction beyond niacin monotherapy.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is an atherogenic lipoprotein associated with atherosclerotic cardiovascular disease. Niacin and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) both lower Lp(a).
Objective: The objective of the study was to determine if addition of PCSK9i to background niacin therapy further lowers Lp(a).
Methods: This study is a retrospective analysis of patients who met the following inclusion criteria: initiated PCSK9i therapy, had Lp(a) measurements before and after initiation of PCSK9i, and for the combination therapy group, PCSK9i was added on top of baseline niacin monotherapy. Of the 150 patients included in this study, 136 were on monotherapy (PCSK9i) and 14 were on combination therapy (niacin + PCSK9i). Lp(a) values were assessed in both groups before and after the addition of PCSK9i.
Results: Median percent and absolute Lp(a) reductions in the niacin + PCSK9i combination therapy group were -15.3% (interquartile range [IQR] -31.8, -1) and -9 mg/dL (IQR -37.2, -0.5), respectively, from a baseline Lp(a) of 95 mg/dL (IQR 20.5, 171). These reductions were statistically significant or nearly so (P = .04 and P = .05, respectively). Median percent and absolute Lp(a) reductions in the PCSK9i monotherapy group were -17.3% (IQR -34.4, 0) and -6 mg/dL (IQR -16, 0), respectively, from a baseline Lp(a) of 39.5 mg/dL (IQR 15, 117.5). There was no difference in median percent and absolute change in Lp(a) between monotherapy and combination therapy groups (P = .84 and P = .54, respectively).
Conclusions: Our study demonstrates that the addition of PCSK9i to background of niacin therapy is associated with ∼15% reduction in Lp(a) beyond that achieved with background niacin monotherapy.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.