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阿司匹林与脂蛋白(a)在一级预防中的作用。

Aspirin and lipoprotein(a) in primary prevention.

机构信息

Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA.

出版信息

Curr Opin Lipidol. 2023 Oct 1;34(5):214-220. doi: 10.1097/MOL.0000000000000891. Epub 2023 Jul 31.

DOI:10.1097/MOL.0000000000000891
PMID:37527183
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11216950/
Abstract

PURPOSE OF REVIEW

Lipoprotein(a) [Lp(a)] is causally associated with cardiovascular diseases, and elevated levels are highly prevalent. However, there is a lack of available therapies to address Lp(a)-mediated risk. Though aspirin has progressively fallen out of favor for primary prevention, individuals with high Lp(a) may represent a high-risk group that derives a net benefit.

RECENT FINDINGS

Aspirin has been demonstrated to have a clear benefit in secondary prevention of cardiovascular disease, but recent primary prevention trials have at best demonstrated a small benefit. However, individuals with elevated Lp(a) may be of high risk enough to benefit, particularly given interactions between Lp(a) and the fibrinolytic system / platelets, and the lack of available targeted medical therapies. In secondary analyses of the Women's Health Study (WHS) and the Aspirin in Reducing Events in the Elderly (ASPREE) trial, aspirin use was associated with a significant reduction in cardiovascular events in carriers of genetic polymorphisms associated with elevated Lp(a) levels. Further studies are needed, however, as these studies focused on narrower subsets of the overall population and genetic markers.

SUMMARY

Individuals with elevated Lp(a) may benefit from aspirin therapy in primary prevention, but further study with plasma Lp(a) levels, broader populations, and randomization of aspirin are needed.

摘要

目的综述

脂蛋白(a) [Lp(a)]与心血管疾病有因果关系，其水平升高的情况非常普遍。然而，目前缺乏可用的疗法来解决 Lp(a)介导的风险。尽管阿司匹林在一级预防中的应用逐渐减少，但高 Lp(a)水平的个体可能代表一个高风险群体，可以从中获得净收益。

最新发现

阿司匹林已被证明在心血管疾病的二级预防中有明确的益处，但最近的一级预防试验最多只显示出了很小的益处。然而，升高的 Lp(a)水平可能使个体处于足够高的风险之中，从而受益，尤其是考虑到 Lp(a)与纤溶系统/血小板之间的相互作用，以及缺乏可用的靶向药物治疗。在 Women's Health Study (WHS)和 Aspirin in Reducing Events in the Elderly (ASPREE)试验的二次分析中，携带与 Lp(a)水平升高相关的遗传多态性的个体使用阿司匹林与心血管事件的显著减少相关。然而，还需要进一步的研究，因为这些研究集中在总体人群和遗传标记的更窄亚组上。

总结

升高的 Lp(a)水平的个体可能从一级预防中的阿司匹林治疗中获益，但需要进一步研究血浆 Lp(a)水平、更广泛的人群和阿司匹林的随机分组。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b640/11216950/4028be455be3/nihms-2003894-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b640/11216950/b0798b0bbefb/nihms-2003894-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b640/11216950/4028be455be3/nihms-2003894-f0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b640/11216950/b0798b0bbefb/nihms-2003894-f0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b640/11216950/4028be455be3/nihms-2003894-f0002.jpg

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J Clin Med. 2022 Oct 13;11(20):6040. doi: 10.3390/jcm11206040.
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J Am Coll Cardiol. 2022 Oct 4;80(14):1287-1298. doi: 10.1016/j.jacc.2022.07.027.
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