Mackinnon L T, Hubinger L M
Department of Human Movement Studies, University of Queensland, Brisbane, Australia.
Sports Med. 1999 Jul;28(1):11-24. doi: 10.2165/00007256-199928010-00002.
Lipoprotein(a) [Lp(a)] is a unique lipoprotein complex in the blood. At high levels (> 30 mg/dl), Lp(a) is considered an independent risk factor for cardiovascular diseases. Serum Lp(a) levels are largely genetically determined, remain relatively constant within a given individual, and do not appear to be altered by factors known to influence other lipoproteins (e.g. lipid-lowering drugs, dietary modification and change in body mass). Since regular exercise is associated with favourable changes in lipoproteins in the blood, recent attention has focused on whether serum Lp(a) levels are also influenced by physical activity. Population and cross-sectional studies consistently show a lack of association between serum Lp(a) levels and regular moderate physical activity. Moreover, exercise intervention studies extending from 12 weeks to 4 years indicate that serum Lp(a) levels do not change in response to moderate exercise training, despite improvements in fitness level and other lipoprotein levels in the blood. However, recent studies suggest the possibility that serum Lp(a) levels may increase in response to intense load-bearing exercise training, such as distance running or weight lifting, over several months to years. Cross-sectional studies have reported abnormally high serum Lp(a) levels in experienced distance runners and body builders who train for 2 to 3 hours each day. However, the possible confounding influence of racial or ethnic factors in these studies cannot be discounted. Recent intervention studies also suggest that 9 to 12 months of intense exercise training may elevate serum Lp(a) levels. However, these changes are generally modest (10 to 15%) and, in most individuals, serum Lp(a) levels remain within the recommended range. It is unclear whether increased serum Lp(a) levels after intense exercise training are of clinical relevance, and whether certain Lp(a) isoforms are more sensitive to the effects of exercise training. Since elevation of both low density lipoprotein cholesterol (LDL-C) and Lp(a) levels in the blood exerts a synergistic effect on cardiovascular disease risk, attention should focus on changing lifestyle factors to decrease LDL-C (e.g. dietary intervention) and increase high density lipoprotein cholesterol (e.g. exercise) levels in the blood.
脂蛋白(a)[Lp(a)]是血液中一种独特的脂蛋白复合物。当Lp(a)水平较高(>30mg/dl)时，它被认为是心血管疾病的一个独立危险因素。血清Lp(a)水平在很大程度上由基因决定，在个体内相对稳定，并且似乎不会受到已知影响其他脂蛋白的因素(如降脂药物、饮食调整和体重变化)的改变。由于规律运动与血液中脂蛋白的有益变化相关，最近的研究重点集中在血清Lp(a)水平是否也受身体活动的影响。人群研究和横断面研究一致表明血清Lp(a)水平与规律的适度身体活动之间缺乏关联。此外，持续12周至4年的运动干预研究表明，尽管血液中的健康水平和其他脂蛋白水平有所改善，但血清Lp(a)水平不会因适度运动训练而改变。然而，最近的研究表明，在数月至数年的时间里，血清Lp(a)水平可能会因高强度负重运动训练(如长跑或举重)而升高。横断面研究报告称，每天训练2至3小时的有经验的长跑运动员和健美运动员的血清Lp(a)水平异常高。然而，这些研究中种族或民族因素可能存在的混杂影响不能被忽视。最近的干预研究还表明，9至12个月的高强度运动训练可能会提高血清Lp(a)水平。然而，这些变化通常较小(10%至15%)，并且在大多数个体中，血清Lp(a)水平仍保持在推荐范围内。目前尚不清楚高强度运动训练后血清Lp(a)水平升高是否具有临床相关性，以及某些Lp(a)异构体是否对运动训练的影响更敏感。由于血液中低密度脂蛋白胆固醇(LDL-C)和Lp(a)水平的升高对心血管疾病风险具有协同作用，因此应将注意力集中在改变生活方式因素上，以降低血液中的LDL-C(如饮食干预)并提高高密度脂蛋白胆固醇(如运动)水平。
