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饮食与 Lp(a)：饮食改变是否能改变 Lp(a)带来的残余心血管风险？

Diet and Lp(a): Does Dietary Change Modify Residual Cardiovascular Risk Conferred by Lp(a)?

机构信息

Department of Internal Medicine, School of Medicine, University of California Davis, Davis, CA 95616, USA.

Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA.

出版信息

Nutrients. 2020 Jul 7;12(7):2024. doi: 10.3390/nu12072024.

DOI:10.3390/nu12072024
PMID:32646066
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7400957/
Abstract

Lipoprotein(a) [Lp(a)] is an independent, causal, genetically determined risk factor for cardiovascular disease (CVD). We provide an overview of current knowledge on Lp(a) and CVD risk, and the effect of pharmacological agents on Lp(a). Since evidence is accumulating that diet modulates Lp(a), the focus of this paper is on the effect of dietary intervention on Lp(a). We identified seven trials with 15 comparisons of the effect of saturated fat (SFA) replacement on Lp(a). While replacement of SFA with carbohydrate, monounsaturated fat (MUFA), or polyunsaturated fat (PUFA) consistently lowered low-density lipoprotein cholesterol (LDL-C), heterogeneity in the Lp(a) response was observed. In two trials, Lp(a) increased with carbohydrate replacement; one trial showed no effect and another showed Lp(a) lowering. MUFA replacement increased Lp(a) in three trials; three trials showed no effect and one showed lowering. PUFA or PUFA + MUFA inconsistently affected Lp(a) in four trials. Seven trials of diets with differing macronutrient compositions showed similar divergence in the effect on LDL-C and Lp(a). The identified clinical trials show diet modestly affects Lp(a) and often in the opposing direction to LDL-C. Further research is needed to understand how diet affects Lp(a) and its properties, and the lack of concordance between diet-induced LDL-C and Lp(a) changes.

摘要

脂蛋白(a) [Lp(a)] 是心血管疾病 (CVD) 的独立、因果、遗传决定的危险因素。我们提供了当前关于 Lp(a) 和 CVD 风险的知识概述，以及药物对 Lp(a) 的影响。由于越来越多的证据表明饮食可以调节 Lp(a)，因此本文的重点是饮食干预对 Lp(a) 的影响。我们确定了七项试验，其中有 15 项比较了饱和脂肪 (SFA) 替代对 Lp(a) 的影响。虽然用碳水化合物、单不饱和脂肪 (MUFA) 或多不饱和脂肪 (PUFA) 替代 SFA 可以降低低密度脂蛋白胆固醇 (LDL-C)，但观察到 Lp(a) 反应存在异质性。在两项试验中，碳水化合物替代会增加 Lp(a)；一项试验没有效果，另一项试验则降低了 Lp(a)。在三项试验中，MUFA 替代会增加 Lp(a)；三项试验没有效果，一项试验降低了 Lp(a)。在四项试验中，PUFA 或 PUFA+MUFA 对 Lp(a) 的影响不一致。七项不同宏量营养素组成的饮食试验显示，对 LDL-C 和 Lp(a) 的影响也存在类似的差异。已确定的临床试验表明，饮食对 Lp(a)的影响适度，而且通常与 LDL-C 的影响方向相反。需要进一步研究来了解饮食如何影响 Lp(a)及其特性，以及饮食诱导的 LDL-C 和 Lp(a)变化之间缺乏一致性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/6f6a4b3dd856/nutrients-12-02024-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/7d501221eb72/nutrients-12-02024-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/85716ebd75d5/nutrients-12-02024-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/6f6a4b3dd856/nutrients-12-02024-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/7d501221eb72/nutrients-12-02024-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/85716ebd75d5/nutrients-12-02024-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95b1/7400957/6f6a4b3dd856/nutrients-12-02024-g003.jpg

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