目的:鉴于Lp(a)在心血管疾病中的因果作用的巩固证据,意大利动脉粥样硬化研究学会(SISA)就Lp(a)遗传学和流行病学达成了共识,以及对其测量的建议以及降低其血浆水平的当前和新兴治疗方法。还提供了有关意大利人口的数据。
结果:Lp(a)由一个apo(a)分子和与低密度脂蛋白(LDL)非常相似的脂蛋白组成。它与低密度脂蛋白相似,连同其携带氧化磷脂的能力一起被认为是使Lp(a)对心血管健康有害的两个主要特征。血浆Lp(a)浓度在人类中变化约1000倍,并且是遗传决定的,因此,它们在任何个体中都相当稳定。孟德尔随机研究表明,Lp(a)在动脉粥样硬化性心血管疾病(ASCVD)和主动脉瓣狭窄中具有因果关系,观察性研究表明,心血管疾病与Lp(a)血浆水平之间存在线性直接相关。强烈建议在患者一生中进行一次Lp(a)测量,特别是在FH科目中,但也作为初始脂质筛查的一部分,以评估心血管风险。apo(a)大小多态性代表了血浆中Lp(a)测量的挑战,但是新的战略正在克服这些困难。Lp(a)水平的降低目前只能通过血浆单采术来实现,适度,用PCSK9抑制剂治疗。
结论:正在等待选择性Lp(a)降低药物的批准,强烈建议对Lp(a)水平升高的个体进行其他危险因素的强化管理.
In view of the consolidating evidence on the causal role of Lp(a) in cardiovascular disease, the Italian Society for the Study of Atherosclerosis (SISA) has assembled a
consensus on Lp(a) genetics and epidemiology, together with recommendations for its measurement and current and emerging therapeutic approaches to reduce its plasma levels. Data on the Italian population are also provided.
Lp(a) is constituted by one apo(a) molecule and a lipoprotein closely resembling to a low-density lipoprotein (LDL). Its similarity with an LDL, together with its ability to carry oxidized phospholipids are considered the two main features making Lp(a) harmful for cardiovascular health. Plasma Lp(a) concentrations vary over about 1000 folds in humans and are genetically determined, thus they are quite stable in any individual. Mendelian Randomization studies have suggested a causal role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis and observational studies indicate a linear direct correlation between cardiovascular disease and Lp(a) plasma levels. Lp(a) measurement is strongly recommended once in a patient\'s lifetime, particularly in FH subjects, but also as part of the initial lipid screening to assess cardiovascular risk. The apo(a) size polymorphism represents a challenge for Lp(a) measurement in plasma, but new strategies are overcoming these difficulties. A reduction of Lp(a) levels can be currently attained only by plasma apheresis and, moderately, with PCSK9 inhibitor treatment.
Awaiting the approval of selective Lp(a)-lowering drugs, an intensive management of the other risk factors for individuals with elevated Lp(a) levels is strongly recommended.