Elias Björnson, Martin Adiels, Jan Borén, Chris J Packard
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引用次数: 0
Abstract
Purpose of review: Lipoprotein(a) has been identified as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. However, as reviewed here, there is ongoing debate as to the key pathogenic features of Lp(a) particles and the degree of Lp(a) atherogenicity relative to low-density lipoprotein (LDL).
Recent findings: Genetic analyses have revealed that Lp(a) on a per-particle basis is markedly (about six-fold) more atherogenic than LDL. Oxidized phospholipids carried on Lp(a) have been found to have substantial pro-inflammatory properties triggering pathways that may contribute to atherogenesis. Whether the strength of association of Lp(a) with ASCVD risk is dependent on inflammatory status is a matter of current debate and is critical to implementing intervention strategies. Contradictory reports continue to appear, but most recent studies in large cohorts indicate that the relationship of Lp(a) to risk is independent of C-reactive protein level.
Summary: Lp(a) is a highly atherogenic lipoprotein and a viable target for intervention in a significant proportion of the general population. Better understanding the basis of its enhanced atherogenicity is important for risk assessment and interpreting intervention trials.
综述目的:脂蛋白(a)已被确定为动脉粥样硬化性心血管疾病(ASCVD)和主动脉瓣狭窄的致病风险因素。然而,正如本文所述,关于脂蛋白(a)颗粒的主要致病特征以及脂蛋白(a)相对于低密度脂蛋白(LDL)的致动脉粥样硬化程度仍存在争议:遗传分析表明,脂蛋白(a)单个颗粒的致动脉粥样硬化性明显高于低密度脂蛋白(约六倍)。研究发现,脂蛋白(a)上的氧化磷脂具有很大的促炎特性,可触发可能导致动脉粥样硬化的途径。脂蛋白(a)与 ASCVD 风险的关联强度是否取决于炎症状态是目前争论的一个问题,也是实施干预策略的关键。相互矛盾的报告不断出现,但最近在大型队列中进行的大多数研究表明,脂蛋白(a)与风险的关系与 C 反应蛋白水平无关。摘要:脂蛋白(a)是一种高度致动脉粥样硬化的脂蛋白,是对相当一部分普通人群进行干预的可行目标。更好地了解其增强致动脉粥样硬化性的基础对于风险评估和解释干预试验非常重要。
期刊介绍:
Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.