Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Department of Blood Sciences and NIHR MedTech and IVD Centre, Newcastle Upon Tyne Hospitals, Newcastle Upon Tyne, UK.
Atherosclerosis. 2019 Dec;291:62-70. doi: 10.1016/j.atherosclerosis.2019.10.011. Epub 2019 Oct 14.
Lipoprotein(a), Lp(a), is a modified atherogenic low-density lipoprotein particle that contains apolipoprotein(a). Its levels are highly heritable and variable in the population. This consensus statement by HEART UK is based on the evidence that Lp(a) is an independent cardiovascular disease (CVD) risk factor, provides recommendations for its measurement in clinical practice and reviews current and emerging therapeutic strategies to reduce CVD risk. Ten statements summarise the most salient points for practitioners and patients with high Lp(a). HEART UK recommends that Lp(a) is measured in adults as follows: 1) those with a personal or family history of premature atherosclerotic CVD; 2) those with first-degree relatives who have Lp(a) levels >200 nmol/l; 3) patients with familial hypercholesterolemia; 4) patients with calcific aortic valve stenosis and 5) those with borderline (but <15%) 10-year risk of a cardiovascular event. The management of patients with raised Lp(a) levels should include: 1) reducing overall atherosclerotic risk; 2) controlling dyslipidemia with a desirable non-HDL-cholesterol level of <100 mg/dl (2.5 mmol/l) and 3) consideration of lipoprotein apheresis.
脂蛋白(a)(Lp(a))是一种经过修饰的致动脉粥样硬化的低密度脂蛋白颗粒,其中含有载脂蛋白(a)。它的水平在人群中具有高度遗传性和可变性。英国心脏协会(HEART UK)的这份共识声明基于以下证据:Lp(a)是一种独立的心血管疾病(CVD)风险因素,为其在临床实践中的测量提供了建议,并回顾了当前和新兴的降低 CVD 风险的治疗策略。十条陈述总结了高 Lp(a 患者的医生和患者最关心的要点。HEART UK 建议如下在成年人中测量 Lp(a):1)有早发性动脉粥样硬化性 CVD 个人或家族史的人;2)一级亲属 Lp(a)水平>200 nmol/l 的人;3)家族性高胆固醇血症患者;4)有钙化性主动脉瓣狭窄的患者;5)边界(但<15%)10 年心血管事件风险的患者。升高的 Lp(a)水平患者的管理应包括:1)降低整体动脉粥样硬化风险;2)控制血脂异常,使非高密度脂蛋白胆固醇水平达到<100 mg/dl(2.5 mmol/l);3)考虑脂蛋白吸附治疗。