Department of Pediatric Endocrinology, Fort Worth, Texas, USA.
Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
Curr Opin Endocrinol Diabetes Obes. 2021 Apr 1;28(2):159-173. doi: 10.1097/MED.0000000000000624.
Summarize recent recommendations on clinical management of adults and youth with elevated lipoprotein(a) [Lp(a)] who are at-risk of or affected by cardiovascular disease (CVD).
There is ample evidence to support elevated Lp(a) levels, present in approximately 20% of the general population, as a causal, independent risk factor for CVD and its role as a significant risk enhancer. Several guidelines and position statements have been published to assist in the identification, treatment and follow-up of adults with elevated levels of Lp(a). There is growing interest in Lp(a) screening and strategies to improve health behaviors starting in youth, although published recommendations for this population are limited. In addition to the well established increased risk of myocardial infarction, stroke and valvular aortic stenosis, data from the coronavirus pandemic suggest adults with elevated Lp(a) may have a particularly high-risk of cardiovascular complications. Lp(a)-specific-lowering therapies are currently in development. Despite their inability to lower Lp(a), use of statins have been shown to improve outcomes in primary and secondary prevention.
Considerable differences exist amongst published guidelines for adults on the use of Lp(a) in clinical practice, and recommendations for youth are limited. With increasing knowledge of Lp(a)'s role in CVD, including recent observations of COVID-19-related risk of cardiovascular complications, more harmonized and comprehensive guidelines for Lp(a) in clinical practice are required. This will facilitate clinical decision-making and help define best practices for identification and management of elevated Lp(a) in adults and youth.
总结近期有关心血管疾病（CVD）高危或已患 CVD 的成年人和青少年脂蛋白（a）[Lp(a)]升高的临床管理建议。
大量证据支持升高的 Lp(a)水平（约占普通人群的 20%）是 CVD 的一个因果独立危险因素，其作用是显著的风险增强因子。已经发表了若干指南和立场声明，以协助识别、治疗和随访成年人中升高的 Lp(a)水平。人们越来越关注从青少年开始进行 Lp(a)筛查和改善健康行为的策略，尽管针对该人群的建议有限。除了众所周知的心肌梗死、中风和主动脉瓣狭窄风险增加外，来自冠状病毒大流行的数据表明，Lp(a)升高的成年人可能面临特别高的心血管并发症风险。目前正在开发 Lp(a）特异性降低疗法。尽管它们不能降低 Lp(a)水平，但他汀类药物的使用已被证明可以改善一级和二级预防的结果。
在成人临床实践中使用 Lp(a)方面，不同指南之间存在相当大的差异，并且针对青少年的建议有限。随着对 Lp(a)在 CVD 中的作用的了解不断增加，包括最近对 COVID-19 相关心血管并发症风险的观察，需要制定更协调和全面的 Lp(a)临床实践指南。这将有助于临床决策，并有助于确定识别和管理成人和青少年升高的 Lp(a)的最佳实践。
