Kurt Bilgen, Soufi Muhidien, Sattler Alexander, Schaefer Juergen R
Internal Medicine, Preventive Cardiology, University Clinic Gießen and Marburg, 35033, Marburg, Germany.
Clin Res Cardiol Suppl. 2015 Apr;10(Suppl 1):26-32. doi: 10.1007/s11789-015-0075-z.
Lipoprotein(a) (Lp(a)) was first described by K. Berg and is known for more than 50 years. It is an interesting particle and combines the atherogenic properties of low-density lipoprotein (LDL)-cholesterol as well as the thrombogenic properties of plasminogen inactivation. However, due to technical problems and publication of negative trials the potential role of Lp(a) in atherosclerosis was severely underestimated. In recent years our understanding of the function and importance of Lp(a) improved. Interventional trials with niacin failed to demonstrate any benefit of lowering Lp(a); however, several studies confirmed the residual cardiovascular disease (CVD) risk of elevated Lp(a). LDL/Lp(a) apheresis is able to lower Lp(a) and some new drugs under development should help us to lower Lp(a) in the near future. It will be important to follow this with hard endpoint trials. Until then most clinicians recommend the use of an aggressive LDL-lowering approach in patients with high Lp(a). Since most of these patients with high Lp(a) might have manifested atherosclerosis anyway, we would also consider the use of acetylsalicylic acid.
脂蛋白(a) [Lp(a)] 最早由K. 伯格描述，至今已有50多年的历史。它是一种有趣的颗粒，兼具低密度脂蛋白（LDL）胆固醇的致动脉粥样硬化特性以及纤溶酶原失活的促血栓形成特性。然而，由于技术问题以及阴性试验的发表，Lp(a)在动脉粥样硬化中的潜在作用被严重低估。近年来，我们对Lp(a)的功能和重要性的认识有所提高。烟酸干预试验未能证明降低Lp(a)有任何益处；然而，多项研究证实Lp(a)升高存在残余心血管疾病（CVD）风险。LDL/Lp(a) 血液成分分离术能够降低Lp(a)，一些正在研发的新药有望在不久的将来帮助我们降低Lp(a)。随后进行硬终点试验将很重要。在此之前，大多数临床医生建议对Lp(a) 水平高的患者采用积极的降低LDL的方法。由于大多数Lp(a) 水平高的患者可能无论如何都已出现动脉粥样硬化，我们也会考虑使用阿司匹林。
