U.O. Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
J Clin Pharm Ther. 2012 Feb;37(1):1-3. doi: 10.1111/j.1365-2710.2011.01244.x. Epub 2011 Jan 30.
There is a growing body of experimental and clinical evidence for the atherogenic and pro-thrombotic potential of Lipoprotein(a) [Lp(a)], as well as for its causative role in coronary heart disease and stroke. We comment on novel strategies for reducing Lp(a) levels.
Irrespective of the underlying biological mechanisms explaining the athero-thrombotic potential of this lipoprotein, most work has focused on the identification of suitable therapies for hyperlipoproteinemia(a). These include apheresis techniques, nicotinic acid and statins. None of these strategies have been shown to be definitely effective or convenient for the patient and new strategies are being attempted. Promising results are emerging with therapeutic interventions targeting the 'inflammatory pathways' by inhibition of Interleukin-6 (IL-6) signalling with natural compounds (e.g., Ginko biloba) or the IL-6 receptor antibody Tocilizumab. These may both lower Lp(a) and cardiovascular risk of the patients. Besides inhibiting platelet function, antiplatelet therapy with aspirin may also decrease the plasma concentration of Lp(a) and modulate its influence on platelets.
We highlight the inadequacy of current approaches for lowering Lp(a) and draw attention to novel insights that may lead to better treatment.
越来越多的实验和临床证据表明脂蛋白(a)[Lp(a)]具有动脉粥样硬化和促血栓形成的潜力，以及其在冠心病和中风中的致病作用。我们对降低 Lp(a)水平的新策略进行了评论。
无论解释这种脂蛋白的动脉粥样硬化潜力的潜在生物学机制如何，大多数工作都集中在确定针对高脂血症(a)的合适治疗方法上。这些方法包括血浆分离术、烟酸和他汀类药物。这些策略都没有被证明对患者有效或方便，正在尝试新的策略。通过抑制白细胞介素-6(IL-6)信号通路来靶向“炎症途径”的治疗干预措施，如天然化合物(如银杏叶)或 IL-6 受体抗体托珠单抗，可能会降低 Lp(a)和患者的心血管风险。这些方法不仅可以抑制血小板功能，阿司匹林等抗血小板治疗也可以降低血浆中 Lp(a)的浓度，并调节其对血小板的影响。
我们强调了目前降低 Lp(a)水平的方法的不足，并提请注意可能导致更好治疗的新见解。
