Abstract：
This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do not support Lp(a) as a risk factor for venous thrombotic events and impaired fibrinolysis. Very low Lp(a) levels may associate with increased risk of diabetes mellitus meriting further study. Lp(a) has pro-inflammatory and pro-atherosclerotic properties, which may partly relate to the oxidized phospholipids carried by Lp(a). This panel recommends testing Lp(a) concentration at least once in adults; cascade testing has potential value in familial hypercholesterolaemia, or with family or personal history of (very) high Lp(a) or premature ASCVD. Without specific Lp(a)-lowering therapies, early intensive risk factor management is recommended, targeted according to global cardiovascular risk and Lp(a) level. Lipoprotein apheresis is an option for very high Lp(a) with progressive cardiovascular disease despite optimal management of risk factors. In conclusion, this statement reinforces evidence for Lp(a) as a causal risk factor for cardiovascular outcomes. Trials of specific Lp(a)-lowering treatments are critical to confirm clinical benefit for cardiovascular disease and aortic valve stenosis.
摘要：
2022年欧洲动脉粥样硬化协会脂蛋白（a）[Lp（a）]共识声明更新了Lp（a）在动脉粥样硬化性心血管疾病（ASCVD）和主动脉瓣狭窄中的作用的证据。为检测和治疗Lp(a)水平升高提供临床指导，并考虑将其纳入全球风险估计。涉及数十万人的流行病学和遗传学研究强烈支持不同种族的Lp（a）浓度与心血管结局之间的因果关系；即使在低密度脂蛋白胆固醇水平非常低的情况下，Lp（a）升高也是一个危险因素。高Lp（a）与主动脉瓣的微钙化和大钙化有关。目前的研究结果不支持Lp（a）作为静脉血栓事件和纤溶受损的危险因素。极低的Lp（a）水平可能与糖尿病风险增加有关，值得进一步研究。Lp（a）具有促炎和促动脉粥样硬化的特性，这可能部分与Lp（a）携带的氧化磷脂有关。该小组建议在成人中至少测试一次Lp（a）浓度；级联测试在家族性高胆固醇血症中具有潜在价值，或具有（非常）高Lp（a）或过早ASCVD的家族或个人病史。没有特定的Lp（a）降低疗法，建议早期强化风险因素管理，根据全球心血管风险和Lp（a）水平有针对性。尽管对风险因素进行了最佳管理，但脂蛋白单采术是患有进行性心血管疾病的极高Lp（a）的一种选择。总之,这一声明加强了Lp(a)作为心血管结局的因果危险因素的证据.特定的降低Lp（a）治疗的试验对于确认心血管疾病和主动脉瓣狭窄的临床益处至关重要。
