Koschinsky Marlys L, Soffer Daniel E, Boffa Michael B
Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada (Dr Koschinsky); Robarts Research institute, Canada (Drs Koschinsky and Boffa).
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA (Dr Soffer).
J Clin Lipidol. 2024 Nov-Dec;18(6):e886-e892. doi: 10.1016/j.jacl.2024.06.005. Epub 2024 Jul 2.
This is an exciting time in the lipoprotein(a) [Lp(a)] field. Attention to this important lipoprotein and potent cardiovascular risk marker is transitioning from the purview of the specialist to that of the general practitioner. Its clinical adoption as an important test is increasing in momentum. There is evidence that Lp(a) contributes to the pathology of atherothrombotic disease, aortic valve stenosis, and childhood ischemic strokes. Three large, Phase 3, randomized, cardiovascular outcomes trials in which Lp(a) is specifically and substantially lowered by mRNA-directed therapies in secondary prevention settings are in progress and will start to report results as early as 2025. Regardless of outcomes, there remain many unanswered questions about Lp(a), ranging from fundamental unknowns about Lp(a) biology, to the complexity of its measurement, optimal screening strategies, and clinical management in individuals with high Lp(a) levels both with and without overt cardiovascular disease. Accordingly, The National Lipid Association (NLA) convened an Expert Discussion involving clinicians and fundamental researchers to identify knowledge gaps in our understanding of Lp(a) biology and pathogenicity and to discuss approaches in the management of elevated Lp(a) in different clinical settings.
这是脂蛋白(a)[Lp(a)]领域令人兴奋的时期。对这种重要的脂蛋白及强大的心血管风险标志物的关注正从专科医生的范畴转向全科医生。其作为一项重要检测在临床中的应用正日益兴起。有证据表明，Lp(a)在动脉粥样硬化血栓形成性疾病、主动脉瓣狭窄和儿童缺血性卒中的病理过程中起作用。三项大型3期随机心血管结局试验正在进行，在二级预防环境中，通过信使核糖核酸定向疗法可使Lp(a)显著降低，最早将于2025年开始报告结果。无论结果如何，关于Lp(a)仍有许多未解决的问题，从Lp(a)生物学的基本未知，到其测量的复杂性、最佳筛查策略以及Lp(a)水平高的个体（无论有无明显心血管疾病）的临床管理。因此，美国国家脂质协会(NLA)召集了一次专家讨论会，参会人员包括临床医生和基础研究人员，以确定我们在理解Lp(a)生物学和致病性方面的知识空白，并讨论在不同临床环境中管理Lp(a)升高的方法。
