Lipoprotein(a) in clinical practice: Risk stratification and therapeutic strategies.

IF 3.6 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Nadim Nasrallah, Mark Atallah, Tarek Harb, Gary Gerstenblith, Thorsten M Leucker
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引用次数: 0

Abstract

Background: Lipoprotein(a) [Lp(a)] is a primarily genetically determined, causal and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Lp(a) levels are stable, unaffected by lifestyle, and best measured using isoform-insensitive, molar-based assays. Current guidelines from the European Atherosclerosis Society and U.S. National Lipid Association recommend a one-time Lp(a) measurement in all adults. Cascade testing is advised in affected families.

Results: Elevated Lp(a) levels are associated with increased risk of coronary artery disease, myocardial infarction incidence and recurrence, and aortic stenosis onset and progression. In cerebrovascular disease, high Lp(a) is linked to large artery ischemic stroke incidence and recurrence, as well as poor functional outcomes. Associations with venous thromboembolism are limited to prothrombotic states and extreme Lp(a) concentrations. Elevated levels (≥50 mg/dL or ≥125 nmol/L) should prompt intensified risk factor modification.

Conclusion: There are no currently approved lipid-lowering therapies that substantially reduce Lp(a) levels. Novel agents to lower Lp(a) include antisense oligonucleotides, small interfering ribonucleic acid and small molecules, all of which have shown promising results in phase 2 trials. Ongoing phase 3 trials will evaluate the causal relationship between Lp(a) and ASCVD, and whether lowering Lp(a) reduces cardiovascular outcomes.

脂蛋白(a)在临床实践:风险分层和治疗策略。
背景:脂蛋白(a) [Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的主要遗传决定、因果和独立危险因素。Lp(a)水平是稳定的,不受生活方式的影响,最好使用对异构体不敏感的、基于磨牙的测定法来测量。目前来自欧洲动脉粥样硬化协会和美国国家脂质协会的指南建议对所有成年人进行一次性脂蛋白(a)测量。建议对受影响的家庭进行级联检测。结果:Lp(a)水平升高与冠状动脉疾病、心肌梗死发生率和复发以及主动脉狭窄的发生和进展的风险增加有关。在脑血管疾病中,高Lp(a)与大动脉缺血性卒中的发病率和复发以及功能不良有关。与静脉血栓栓塞的关联仅限于血栓前状态和极端Lp(a)浓度。水平升高(≥50 mg/dL或≥125 nmol/L)应提示加强危险因素的修改。结论:目前还没有批准的降脂疗法可以显著降低Lp(a)水平。降低Lp(a)的新型药物包括反义寡核苷酸、小干扰核糖核酸和小分子,所有这些药物都在2期试验中显示出有希望的结果。正在进行的3期试验将评估Lp(a)和ASCVD之间的因果关系,以及降低Lp(a)是否会降低心血管结局。
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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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