Bhatia Harpreet S, Dalal Sonar, Ross Elsie
Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, San Diego, California.
Kaneka Medical America LLC, New York, New York.
Curr Opin Lipidol. 2025 May 26. doi: 10.1097/MOL.0000000000000999.
Peripheral arterial disease (PAD) is an atherosclerotic and thrombotic disease associated with substantial morbidity and mortality. Although risk factors for PAD are mostly modifiable, prognosis remains poor, and patients are at a high risk of cardiovascular events. This review aims to summarize current evidence surrounding the role of lipoprotein(a) (Lp[a]) in PAD and examines the available data on lipoprotein apheresis as an effective management approach for patients with PAD with elevated Lp(a).
Evidence strongly indicates that elevated Lp(a) is a causal and independent risk factor for PAD and is associated with PAD severity and increased risk of adverse outcomes, including major adverse cardiovascular events and major adverse limb events. Proprotein convertase subtilisin/kexin type 9 inhibitors can modestly reduce Lp(a) levels, and several Lp(a)-lowering therapies are currently under investigation. Prospective cohort studies in patients with PAD with elevated Lp(a) have reported clinical benefits of lipoprotein apheresis, including reduction of cardiovascular event risk.
Limited treatment options exist for patients with PAD and elevated Lp(a). Lipoprotein apheresis is currently the only treatment option approved specifically for lowering Lp(a) levels.
外周动脉疾病（PAD）是一种与严重发病率和死亡率相关的动脉粥样硬化和血栓形成性疾病。尽管PAD的危险因素大多是可改变的，但其预后仍然很差，患者发生心血管事件的风险很高。本综述旨在总结目前关于脂蛋白（a）[Lp（a）]在PAD中的作用的证据，并研究脂蛋白分离术作为治疗Lp（a）升高的PAD患者的有效管理方法的现有数据。
有证据强烈表明，Lp（a）升高是PAD的一个因果性独立危险因素，与PAD严重程度以及不良结局风险增加相关，包括主要不良心血管事件和主要不良肢体事件。前蛋白转化酶枯草溶菌素/kexin 9型抑制剂可适度降低Lp（a）水平，目前有几种降低Lp（a）的疗法正在研究中。对Lp（a）升高的PAD患者进行的前瞻性队列研究报告了脂蛋白分离术的临床益处，包括降低心血管事件风险。
对于Lp（a）升高的PAD患者，治疗选择有限。脂蛋白分离术是目前唯一被批准专门用于降低Lp（a）水平的治疗选择。
