Marcovina Santica M
Medpace Reference Laboratories, Cincinnati, OH, USA.
Crit Rev Clin Lab Sci. 2023 Dec;60(8):560-572. doi: 10.1080/10408363.2023.2229915. Epub 2023 Jul 14.
Lipoprotein(a) is a complex lipoprotein with unique characteristics distinguishing it from all the other apolipoprotein B-containing lipoprotein particles. Its lipid composition and the presence of a single molecule of apolipoprotein B per particle, render lipoprotein(a) similar to low-density lipoproteins. However, the presence of a unique, carbohydrate-rich protein termed apolipoprotein(a), linked by a covalent bond to apolipoprotein B imparts unique characteristics to lipoprotein(a) distinguishing it from all the other lipoproteins. Apolipoprotein(a) is highly polymorphic in size ranging in molecular weight from <300 KDa to >800 kDa. Both the size polymorphism and the concentration of lipoprotein(a) in plasma are genetically determined and unlike other lipoproteins, plasma concentration is minimally impacted by lifestyle modifications or lipid-lowering drugs. Many studies involving hundreds of thousands of individuals have provided strong evidence that elevated lipoprotein(a) is genetically determined and a causal risk factor for atherosclerotic cardiovascular disease. The concentration attained in adulthood is already present in children at around 5 years of age and therefore, those with elevated lipoprotein(a) are prematurely exposed to a high risk of cardiovascular disease. Despite the large number of guidelines and consensus statements on the management of lipoprotein(a) in atherosclerotic cardiovascular disease published in the last decade, lipoprotein(a) is still seldom measured in clinical settings. In this review, we provide an overview of the most important features that characterize lipoprotein(a), its role in cardiovascular disease, and the importance of adding the measurement of lipoprotein(a) for screening adults and youths to identify those at increased risk of atherosclerotic cardiovascular disease due to their elevated plasma concentration of lipoprotein(a).
脂蛋白(a)是一种复杂的脂蛋白，具有独特的特征，使其有别于所有其他含载脂蛋白B的脂蛋白颗粒。其脂质组成以及每个颗粒中单个载脂蛋白B分子的存在，使脂蛋白(a)类似于低密度脂蛋白。然而，一种独特的、富含碳水化合物的蛋白质即载脂蛋白(a)的存在，通过共价键与载脂蛋白B相连，赋予了脂蛋白(a)独特的特征，使其有别于所有其他脂蛋白。载脂蛋白(a)在大小上具有高度多态性，分子量范围从<300 kDa到>800 kDa。载脂蛋白(a)的大小多态性和血浆中的浓度均由基因决定，与其他脂蛋白不同，血浆浓度受生活方式改变或降脂药物的影响极小。许多涉及数十万人的研究提供了强有力的证据，表明脂蛋白(a)升高是由基因决定的，是动脉粥样硬化性心血管疾病的因果危险因素。成年时达到的浓度在5岁左右的儿童中就已存在，因此，脂蛋白(a)升高的人过早面临心血管疾病的高风险。尽管在过去十年中发表了大量关于动脉粥样硬化性心血管疾病中脂蛋白(a)管理的指南和共识声明，但脂蛋白(a)在临床环境中仍很少被检测。在这篇综述中，我们概述了脂蛋白(a)的最重要特征、其在心血管疾病中的作用，以及增加脂蛋白(a)检测以筛查成年人和青少年的重要性，以识别那些由于血浆脂蛋白(a)浓度升高而患动脉粥样硬化性心血管疾病风险增加的人。
