Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Duke School of Medicine, Durham, North Carolina, USA.
Curr Opin Cardiol. 2021 Sep 1;36(5):542-548. doi: 10.1097/HCO.0000000000000901.
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.
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。
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