Parcha Vibhu, Bittner Vera A
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, United States of America.
Am Heart J Plus. 2025 Jul 21;57:100581. doi: 10.1016/j.ahjo.2025.100581. eCollection 2025 Sep.
Lipoprotein(a) [Lp(a)] has emerged as an important, genetically determined, and independent risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease. Despite growing evidence of its causal role in cardiovascular morbidity and mortality, its actionability in primary prevention remains underrecognized. This review highlights the contemporary scientific foundation supporting early Lp(a) measurement, elucidates its pathogenic mechanisms, evaluates the evolving therapeutic landscape, and proposes a pragmatic clinical framework for integrating Lp(a) into preventive cardiology today. Through clinical vignettes and current data, we argue that identifying elevated Lp(a) can meaningfully guide risk reclassification, intensify modifiable risk management, and inform patient-centered preventive strategies thereby making Lp(a) testing actionable in contemporary primary prevention.
脂蛋白(a) [Lp(a)] 已成为动脉粥样硬化性心血管疾病 (ASCVD) 和钙化性主动脉瓣疾病的重要的、由基因决定的独立危险因素。尽管越来越多的证据表明其在心血管疾病的发病和死亡中起因果作用，但其在一级预防中的可操作性仍未得到充分认识。本综述强调了支持早期检测Lp(a)的当代科学基础，阐明了其致病机制，评估了不断发展的治疗前景，并提出了一个将Lp(a)纳入当今预防性心脏病学的实用临床框架。通过临床案例和当前数据，我们认为识别Lp(a)升高可以有效地指导风险重新分类，加强可改变风险的管理，并为以患者为中心的预防策略提供依据，从而使Lp(a)检测在当代一级预防中具有可操作性。
