School of Medicine, Federal University of Uberlandia, Uberlandia, MG, Brazil.
Cardiometabolic Research Institute, Houston, TX, USA.
Clin Ther. 2019 Sep;41(9):1780-1797. doi: 10.1016/j.clinthera.2019.06.002. Epub 2019 Jul 13.
PURPOSE: Cardiovascular (CV) diseases account for most worldwide mortality, and a higher level of lipoprotein (Lp)-(a) is recognized as a prevalent contributing risk factor. However, there is no consensus regarding nutritional strategies for lowering Lp(a) concentration. Thus, the purposes of this literature review were to: (1) critically examine data concerning the effects of dietetic interventions and nutraceutical agents on Lp(a) level; and (2) review the feasibility and utility of their clinical use. METHODS: A literature search was conducted for studies published between August 2018 and March 2019. The search was performed using the Cochrane, Medline, and Web of Science databases. In order to expand the research, there were no delimitations on the type or year of the studies. A total of 1932 articles were identified using this search procedure. After duplicates were eliminated, 740 abstracts of articles written in English were screened to identify those of highest relevance. In the final tally, a total of 152 full-text articles were included in this review. FINDINGS: Several foods and decreases in saturated fat and ethanol intake, especially red wine intake, may lower Lp(a) concentration, but limits are necessary. Coffee and tea intake may decrease Lp(a) level; further investigation is crucial before they can be considered potent Lp(a)-lowering agents. Among supplementation strategies, only l-carnitine and coenzyme Q10 are promising clinical candidates to lower Lp(a) level. Since both l-carnitine and coenzyme Q10 supplementation are commonly used for CV support, they deserve further exploration regarding clinical applicability. In contrast, despite potential CV benefits, current research fails to justify use of higher intakes of vitamin C, soy isoflavones, garlic, and ω-3 for decreasing Lp(a) concentration. IMPLICATIONS: Definitive long-term clinical trials are needed to confirm the effects of dietetic interventions and nutraceutical agents on Lp(a) concentration when anticipating improved CV outcomes.
目的:心血管疾病是全球大多数死亡的主要原因,脂蛋白(a)[Lp(a)]水平升高被认为是普遍存在的致病危险因素。然而,目前对于降低 Lp(a)浓度的营养策略尚无共识。因此,本次文献综述的目的是:(1)批判性地评估饮食干预和营养保健品对 Lp(a)水平的影响的数据;(2)审查其临床应用的可行性和实用性。
方法:检索 2018 年 8 月至 2019 年 3 月期间发表的研究,检索使用 Cochrane、Medline 和 Web of Science 数据库。为了扩大研究范围,对研究类型和年份没有限制。通过该检索程序共识别出 1932 篇文章。消除重复项后,筛选了 740 篇英文文章摘要,以确定最相关的文章。最后,共有 152 篇全文文章纳入本综述。
结果:几种食物和减少饱和脂肪和乙醇摄入,特别是红葡萄酒摄入,可能降低 Lp(a)浓度,但需限量。咖啡和茶的摄入可能会降低 Lp(a)水平;在考虑它们作为有效降 Lp(a)剂之前,还需要进一步研究。在补充策略中,只有左旋肉碱和辅酶 Q10 是有前途的临床候选物,可降低 Lp(a)水平。由于左旋肉碱和辅酶 Q10 的补充通常用于心血管支持,因此值得进一步探索其临床适用性。相比之下,尽管有潜在的心血管益处,但目前的研究无法证明增加维生素 C、大豆异黄酮、大蒜和 ω-3 的摄入量可以降低 Lp(a)浓度。
结论:需要进行明确的长期临床试验,以确认饮食干预和营养保健品对 Lp(a)浓度的影响,从而预期改善心血管结局。
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