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脂蛋白(a):在动脉粥样硬化中的作用和新的治疗选择。

Lipoprotein(a): Role in atherosclerosis and new treatment options.

机构信息

Faculty of Medicine in Novi Sad, University of Novi Sad, Novi Sad, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, Novi Sad, Serbia.

出版信息

Biomol Biomed. 2023 Jul 3;23(4):575-583. doi: 10.17305/bb.2023.8992.


DOI:10.17305/bb.2023.8992
PMID:37183706
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10351089/
Abstract

Atherosclerosis is a chronic process characterized by inflammation and the progressive accumulation of inflammatory cells and lipids in the blood vessel wall, resulting in narrowing of the blood vessel's circumference. Treatment of people with dyslipidemia aims to reduce the risk of developing atherosclerotic disease and prevent major adverse cardiovascular events (MACE). The results of previous studies indicated that lipoprotein(a) (Lp(a)) is a critical causal factor in the estimated risk of developing a cardiovascular (CV) incident even after achieving desirable low-density lipoprotein (LDL) cholesterol levels. Lp(a) is a low-density lipoprotein particle, like LDL cholesterol. The levels of Lp(a) in plasma are genetically determined. Lp(a) catabolism is still controversial. The pathogenic potential of Lp(a) can be divided into three categories: promotion of plaque formation, thrombogenicity, and proinflammatory effects. Lp(a) levels above the 75th percentile reduced the risk of aortic valve stenosis and myocardial infarction, whereas higher levels (above 90th percentile) were associated with an increased risk of heart failure. However, no hypolipidemic agents have been approved for targeted use in patients with high Lp(a) levels. There are insufficient randomized controlled trials assessing CV outcomes that would support the evidence that current treatment options, which effectively lower Lp(a) levels, also effectively prevent CV event. However, according to some studies, there is strong evidence that better CV outcome is one of the benefits of such therapy. The results of ongoing clinical trials are eagerly awaited.

摘要

动脉粥样硬化是一种慢性疾病,其特征为炎症以及炎症细胞和血液中脂质在血管壁的不断堆积,导致血管周长变窄。治疗血脂异常的目的是降低发生动脉粥样硬化性疾病的风险,并预防主要不良心血管事件(MACE)。先前的研究结果表明,脂蛋白(a)[Lp(a)]是估计发生心血管(CV)事件风险的关键致病因素,即使在实现理想的低密度脂蛋白(LDL)胆固醇水平后也是如此。Lp(a)是一种类似于 LDL 胆固醇的低密度脂蛋白颗粒。血浆中 Lp(a)的水平由遗传决定。Lp(a)的代谢仍存在争议。Lp(a)的致病潜能可分为三类:促进斑块形成、血栓形成和促炎作用。Lp(a)水平高于第 75 百分位可降低主动脉瓣狭窄和心肌梗死的风险,而较高水平(高于第 90 百分位)与心力衰竭风险增加相关。然而,尚无专门针对高 Lp(a)水平患者的靶向降脂药物获得批准。目前尚缺乏评估 CV 结局的随机对照试验,无法为当前治疗方案有效降低 Lp(a)水平也能有效预防 CV 事件的证据提供支持。然而,根据一些研究,有强有力的证据表明,这种治疗能带来更好的 CV 结局。正在进行的临床试验结果令人期待。

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引用本文的文献

[1]
Mitochondrial Dysfunction and Atherosclerosis: The Problem and the Search for Its Solution.

Biomedicines. 2025-4-15

[2]
Interaction Between Lipoprotein(a) and Other Lipid Molecules: A Review of the Current Literature.

Biomolecules. 2025-1-22

[3]
Mendelian randomization analysis does not support a causal influence between lipoprotein(A) and immune-mediated inflammatory diseases.

Sci Rep. 2025-1-30

[4]
Low Density Lipoprotein Cholesterol Decreases the Expression of Adenosine A Receptor and Lipid Rafts-Protein Flotillin-1: Insights on Cardiovascular Risk of Hypercholesterolemia.

Cells. 2024-3-11

[5]
The Concentration of PCSK9-Lp(a) Complexes and the Level of Blood Monocytes in Males with Coronary Atherosclerosis.

J Pers Med. 2023-6-29

本文引用的文献

[1]
Lipoprotein(a): Its Association with Calcific Aortic Valve Stenosis, the Emerging RNA-Related Treatments and the Hope for a New Era in "Treating" Aortic Valve Calcification.

J Cardiovasc Dev Dis. 2023-2-23

[2]
There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness.

Am J Prev Cardiol. 2022-8-6

[3]
Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement.

Eur Heart J. 2022-10-14

[4]
Statin therapy for the primary prevention of cardiovascular disease: Pros.

Atherosclerosis. 2022-9

[5]
New, Novel Lipid-Lowering Agents for Reducing Cardiovascular Risk: Beyond Statins.

Diabetes Metab J. 2022-7

[6]
Study design and rationale for the Olpasiran trials of Cardiovascular Events And lipoproteiN(a) reduction-DOSE finding study (OCEAN(a)-DOSE).

Am Heart J. 2022-9

[7]
Lipoprotein(a) and its Significance in Cardiovascular Disease: A Review.

JAMA Cardiol. 2022-7-1

[8]
Lipoprotein(a) levels from childhood to adulthood: Data in nearly 3,000 children who visited a pediatric lipid clinic.

Atherosclerosis. 2022-5

[9]
Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk.

J Am Coll Cardiol. 2022-3-1

[10]
Novel siRNA reduces plasma lipoprotein(a) levels.

Nat Rev Cardiol. 2022-3

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