Liu Taili, Yoon Won-Sik, Lee Sang-Rok
Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea.
Chonnam Med J. 2021 Jan;57(1):36-43. doi: 10.4068/cmj.2021.57.1.36. Epub 2021 Jan 25.
In recent years, epidemiological studies, genome-wide association studies, and Mendelian randomization studies have shown a strong association between increased levels of lipoproteins and increased risks of coronary heart disease and cardiovascular disease (CVD). Although lipoprotein(a) [Lp(a)] was an independent risk factor for ASCVD, the latest international clinical guidelines do not recommend direct reduction of plasma Lp(a) concentrations. The main reason was that there is no effective clinical medicine that directly lowers plasma Lp(a) concentrations. However, recent clinical trials have shown that proprotein convertase subtilisin/kexin-type 9 inhibitors (PCSK9) and second-generation antisense oligonucleotides can effectively reduce plasma Lp(a) levels. This review will present the structure, pathogenicity, prognostic evidences, and recent advances in therapeutic drugs for Lp(a).
近年来,流行病学研究、全基因组关联研究和孟德尔随机化研究表明,脂蛋白水平升高与冠心病和心血管疾病(CVD)风险增加之间存在密切关联。尽管脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的独立危险因素,但最新的国际临床指南并不建议直接降低血浆Lp(a)浓度。主要原因是目前尚无直接降低血浆Lp(a)浓度的有效临床药物。然而,最近的临床试验表明,前蛋白转化酶枯草溶菌素/kexin 9型抑制剂(PCSK9)和第二代反义寡核苷酸可有效降低血浆Lp(a)水平。本文将介绍Lp(a)的结构、致病性、预后证据以及治疗药物的最新进展。