The researchers note that at present, the main treatment for familial hypercholesterolaemia is highly potent statin treatment, and if the main driver of some cases is high lipoprotein(a) [LPA] concentration then the effect of statin treatment might be limited. With the development of novel LPA-lowering treatments, it might be relevant to distinguish between clinical familial hypercholesterolaemia mainly caused by raised LDL cholesterol from that mainly caused by raised LPA.
According to a commentary, these findings reinforce the need for lipoprotein(a) [LPA] concentrations to be measured in patients with hypercholesterolaemia, especially those with familial hypercholesterolaemia. It notes that in view of the interaction of elevated LDL cholesterol and LPA concentrations with myocardial infarction risk, it would be interesting to test whether treatments that reduce both LDL cholesterol and LPA concentrations, such as the PCSK9 inhibitors, will prevent cardiovascular disease beyond expected reduction in LDL cholesterol alone; however, this remains to be proven. For the time being, it advises that one should be cautious with elevated LPA concentrations.