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钙化性主动脉瓣疾病中脂蛋白(a)的现状。

The current landscape of lipoprotein(a) in calcific aortic valvular disease.

机构信息

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Duke School of Medicine, Durham, North Carolina, USA.

出版信息

Curr Opin Cardiol. 2021 Sep 1;36(5):542-548. doi: 10.1097/HCO.0000000000000901.


DOI:10.1097/HCO.0000000000000901
PMID:34397461
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8934151/
Abstract

PURPOSE OF REVIEW: Calcific aortic stenosis (CAVS) is the most common form of valvular heart disease in developed countries, increasing in prevalence with the aging population. Surgical or transcatheter aortic valve replacement is the only treatment available for CAVS. However, these interventions are typically reserved for severe symptomatic aortic stenosis (AS). The purpose of this review is to summarize the recent literature in uncovering the underlying pathophysiology of CAVS in the setting of lipoprotein (a) [Lp(a)] and emerging therapies targeting Lp(a) which may help halt disease progression in CAVS. RECENT FINDINGS: Pathophysiologic, epidemiological, and genetic studies over the past two decades have provided strong evidence that Lp(a) is an important mediator of calcific aortic valvular disease (CAVD). Studies suggest that Lp(a) is a key carrier of pro-calcifying oxidized phospholipids (OxPL). The metabolism of OxPL results in a pro-inflammatory state and subsequent valvular thickening and mineralization through pro-osteogenic signaling. The identification of Lp(a) as a causal mediator of CAVD has allowed for opportunities for emerging therapeutic agents which may slow the progression of CAVD (Fig. 1JOURNAL/cocar/04.03/00001573-202109000-00007/figure1/v/2021-08-04T080204Z/r/image-jpeg). SUMMARY: This review summarizes the current knowledge on the association of Lp(a) with CAVD and ongoing studies of potential Lp(a)-lowering therapies. Based on the rate-limiting and causal role of Lp(a) in progression of CAVS, these therapies may represent novel pharmacotherapies in AS and inform the developing role of Lp(a) in the clinical management of CAVD.

摘要

目的综述:在发达国家,钙化性主动脉瓣狭窄(CAVS)是最常见的瓣膜性心脏病形式,随着人口老龄化,其患病率也在增加。外科或经导管主动脉瓣置换术是治疗 CAVS 的唯一方法。然而,这些干预措施通常仅适用于严重症状性主动脉瓣狭窄(AS)。本文旨在总结脂蛋白(a)[Lp(a)]在钙化性主动脉瓣疾病(CAVD)中的潜在病理生理学以及针对 Lp(a)的新兴治疗方法的最新文献,这些方法可能有助于阻止 CAVS 疾病进展。

最新发现:在过去的二十年中,病理生理学、流行病学和遗传学研究提供了强有力的证据,证明 Lp(a)是钙化性主动脉瓣疾病的重要介质。研究表明,Lp(a)是促钙化氧化磷脂(OxPL)的重要载体。OxPL 的代谢导致促炎状态,随后通过促成骨信号导致瓣膜增厚和矿化。将 Lp(a)鉴定为 CAVD 的因果介质为新兴治疗剂提供了机会,这些治疗剂可能会减缓 CAVD 的进展(图 1)。

总结:本文总结了目前关于 Lp(a)与 CAVD 相关性的知识,以及正在进行的潜在 Lp(a)降低治疗的研究。基于 Lp(a)在 CAVS 进展中的限速和因果作用,这些疗法可能代表 AS 的新型药物治疗方法,并为 Lp(a)在 CAVD 临床管理中的作用提供依据。

相似文献

[1]
The current landscape of lipoprotein(a) in calcific aortic valvular disease.

Curr Opin Cardiol. 2021-9-1

[2]
Lipoprotein(a) and calcific aortic valve disease: current evidence and future directions.

Curr Opin Clin Nutr Metab Care. 2024-1-1

[3]
Lipoprotein(a): Expanding our knowledge of aortic valve narrowing.

Trends Cardiovasc Med. 2021-7

[4]
Association of Mild to Moderate Aortic Valve Stenosis Progression With Higher Lipoprotein(a) and Oxidized Phospholipid Levels: Secondary Analysis of a Randomized Clinical Trial.

JAMA Cardiol. 2018-12-1

[5]
Lipoprotein(a) and Oxidized Phospholipids Promote Valve Calcification in Patients With Aortic Stenosis.

J Am Coll Cardiol. 2019-5-7

[6]
Autotaxin interacts with lipoprotein(a) and oxidized phospholipids in predicting the risk of calcific aortic valve stenosis in patients with coronary artery disease.

J Intern Med. 2016-5-30

[7]
The Prevalence of Lipoprotein(a) Measurement and Degree of Elevation Among 2710 Patients With Calcific Aortic Valve Stenosis in an Academic Echocardiography Laboratory Setting.

Angiology. 2017-10

[8]
Oxidized Phospholipids, Lipoprotein(a), and Progression of Calcific Aortic Valve Stenosis.

J Am Coll Cardiol. 2015-9-15

[9]
Potential Causality and Emerging Medical Therapies for Lipoprotein(a) and Its Associated Oxidized Phospholipids in Calcific Aortic Valve Stenosis.

Circ Res. 2019-2

[10]
Lipoprotein(a) and calcific aortic valve stenosis: A systematic review.

Prog Cardiovasc Dis. 2020-6-8

引用本文的文献

[1]
Association of lipoprotein(a) and LPA gene with calcific aortic valve disease.

Eur J Med Res. 2025-8-22

[2]
Lipoprotein(a): Emerging insights and therapeutics.

Am J Prev Cardiol. 2024-3-29

[3]
Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease.

J Am Coll Cardiol. 2024-3-5

[4]
Lipoprotein(a) and calcific aortic valve disease initiation and progression: a systematic review and meta-analysis.

Cardiovasc Res. 2023-7-6

[5]
Association Between Lipoprotein(a) and Calcific Aortic Valve Disease: A Systematic Review and Meta-Analysis.

Front Cardiovasc Med. 2022-4-25

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