Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA.
Division of Cardiovascular Diseases, Creighton University School of Medicine, Omaha, NE, USA.
Prog Cardiovasc Dis. 2020 Jul-Aug;63(4):496-502. doi: 10.1016/j.pcad.2020.06.002. Epub 2020 Jun 8.
Calcific aortic valve stenosis (AS) is the most common form of acquired valvular heart disease needing intervention and our understanding of this disease has evolved from one of degenerative calcification to that of an active process driven by the interplay of genetic factors and chronic inflammation modulated by risk factors such as smoking, hypertension and elevated cholesterol. Lipoprotein(a) [Lp (a)] is a cholesterol rich particle secreted by the liver which functions as the major lipoprotein carrier of phosphocholine-containing oxidized phospholipids. Lp(a) levels are largely genetically determined by polymorphisms in the LPA gene. While there is an extensive body of evidence linking Lp(a) to atherosclerotic cardiovascular disease, emerging evidence now suggests a similar association of Lp(a) to calcific AS. In this article, we performed a systematic review of all published literature to assess the association between Lp(a) and calcific aortic valve (AV) disease. In addition, we review the potential mechanisms by which Lp(a) influences the progression of valve disease. Our review identified a total of 21 studies, varying from case-control studies, prospective or retrospective observational cohort studies to Mendelian randomized studies that assessed the association between Lp(a) and calcific AS. All but one of the above studies demonstrated significant association between elevated Lp(a) and calcific AS. We conclude that there is convincing evidence supporting a causal association between elevated Lp(a) and calcific AS. In addition, elevated Lp(a) predicts a faster hemodynamic progression of AS, and increased risk of AV replacement, especially in younger patients. Further research into the clinical utility of Lp(a) as a marker for predicting the incidence, progression, and outcomes of sclerodegenerative AV disease is needed.
钙化性主动脉瓣狭窄(AS)是最常见的需要介入治疗的获得性心脏瓣膜病,我们对这种疾病的认识已经从退行性钙化转变为一种由遗传因素和慢性炎症相互作用驱动的活跃过程,这种炎症受到吸烟、高血压和胆固醇升高等危险因素的调节。脂蛋白(a)[Lp(a)]是一种由肝脏分泌的富含胆固醇的颗粒,它是含有磷酸胆碱的氧化磷脂的主要脂蛋白载体。Lp(a)水平主要由 LPA 基因的多态性决定。虽然有大量证据表明 Lp(a)与动脉粥样硬化性心血管疾病有关,但新的证据表明 Lp(a)与钙化性 AS 也有类似的关联。在本文中,我们对所有已发表的文献进行了系统回顾,以评估 Lp(a)与钙化性主动脉瓣(AV)疾病之间的关联。此外,我们还回顾了 Lp(a)影响瓣膜疾病进展的潜在机制。我们的综述共确定了 21 项研究,包括病例对照研究、前瞻性或回顾性观察队列研究以及孟德尔随机研究,这些研究评估了 Lp(a)与钙化性 AS 之间的关联。除一项研究外,上述所有研究均表明 Lp(a)升高与钙化性 AS 之间存在显著关联。我们得出结论,有令人信服的证据支持 Lp(a)升高与钙化性 AS 之间存在因果关系。此外,Lp(a)升高预示着 AS 的血流动力学进展更快,AV 置换的风险增加,尤其是在年轻患者中。需要进一步研究 Lp(a)作为预测硬皮性 AV 疾病发生、进展和结局的标志物的临床应用。
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