Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Lancet. 2024 Sep 28;404(10459):1255-1264. doi: 10.1016/S0140-6736(24)01308-4. Epub 2024 Sep 12.
One in five people are at high risk for atherosclerotic cardiovascular disease and aortic valve stenosis due to high lipoprotein(a). Lipoprotein(a) concentrations are lowest in people from east Asia, Europe, and southeast Asia, intermediate in people from south Asia, the Middle East, and Latin America, and highest in people from Africa. Concentrations are more than 90% genetically determined and 17% higher in post-menopausal women than in men. Individuals at a higher cardiovascular risk should have lipoprotein(a) concentrations measured once in their lifetime to inform those with high concentrations to adhere to a healthy lifestyle and receive medication to lower other cardiovascular risk factors. With no approved drugs to lower lipoprotein(a) concentrations, it is promising that at least five drugs in development lower concentrations by 65-98%, with three currently being tested in large cardiovascular endpoint trials. This Review covers historical perspectives, physiology and pathophysiology, genetic evidence of causality, epidemiology, role in familial hypercholesterolaemia and diabetes, management, screening, diagnosis, measurement, prevention, and future lipoprotein(a)-lowering drugs.
五分之一的人由于脂蛋白(a)水平高，存在患动脉粥样硬化性心血管疾病和主动脉瓣狭窄的高风险。脂蛋白(a)浓度在东亚、欧洲和东南亚人群中最低，在南亚、中东和拉丁美洲人群中居中，在非洲人群中最高。浓度有超过 90%是由遗传决定的，绝经后女性比男性高 17%。心血管风险较高的个体应在其一生中测量一次脂蛋白(a)浓度，以便告知那些浓度较高的个体要保持健康的生活方式，并服用药物来降低其他心血管风险因素。由于没有批准降低脂蛋白(a)浓度的药物，至少有五种正在开发中的药物可将浓度降低 65-98%，其中三种目前正在大型心血管终点试验中进行测试，这令人鼓舞。这篇综述涵盖了历史观点、生理学和病理生理学、因果关系的遗传证据、流行病学、在家族性高胆固醇血症和糖尿病中的作用、管理、筛查、诊断、测量、预防以及未来的脂蛋白(a)降低药物。
