Shapiro MD, et al. - Using data from four randomized, 12-week, multicenter, phase 3 evolocumab trials, researchers assessed the link between LDL-C and Lp(a) lowering by evolocumab (a PCSK9 inhibitor), as well as determined the prevalence of concordant/discordant LDL-C and Lp(a) responses to PCSK9 inhibition among the participants who were patients with familial hypercholesterolemia, nonfamilial hypercholesterolemia, or statin intolerance. They defined concordant response as LDL-C reduction >35% and Lp(a) reduction >10%. Overall, 895 patients (438 female; median age: 59.0 years [interquartile range: 51–66 years]) were included. Findings revealed that, in response to evolocumab, a high prevalence of discordance in LDL-C and Lp(a) reduction was observed. This was specifically found when higher baseline Lp(a) concentrations were taken into account. This indicated that alternative pathways beyond LDLR (LDL receptor)–mediated clearance may be involved in Lp(a) reduction by evolocumab.