Evolocumab Lowers Low-Density-Lipoprotein Cholesterol and Lipoprotein (A) Levels in Nephrotic Syndrome

Ramarao Pradeep

AACE Clinical Case Reports - Sep 2018, Vol. 4, No. 5 (September/October 2018) pp. e415-e418

Low-density-lipoprotein cholesterol (LDL-C) accounts for 75% of the cholesterol carried by non–high-density-lipoprotein (HDL) cholesterol particles (interme-diate-density lipoprotein, LDL-C, very-low-density lipo-protein cholesterol, chylomicron remnants, and lipoprotein a [Lp(a)]). LDL-C can be calculated using the Friedewald equation (LDL = total cholesterol – [HDL + triglycer-ides]/5), which includes the cholesterol carried by Lp(a). Similarly, direct LDL-C measurements do not differenti-ate cholesterol derived from Lp(a). Patients with nephrotic syndrome have high concentrations of Lp(a) (1). Overall, 45% of Lp(a) is cholesterol, and current LDL measurement methods do not separately report cholesterol derived from Lp(a). We report a case of a 56-year-old man with elevat-ed Lp(a) that resulted in pseudo-elevation of LDL-C that was corrected with evolocumab. The degree of decrease in Lp(a) following treatment with evolocumab observed in our patient has not been previously reported.

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