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[Lipoprotein (a)--a mysterious factor in atherogenesis]
Bojan Jelaković1, Mario Laganović, Dusko Kuzmanić
1Zavod za nefrologiju i arterijsku hipertenziju Medicinskog fakulteta Sveucilista u Zagrebu i Klinike za unutrasnje bolesti Klinickoga bolnickog centra Zagreb, Kispatićeva 12, 10000 Zagreb.
Lijecnicki Vjesnik
|April 12, 2003
Summary
Lipoprotein (a) [Lp (a)] is a genetically determined risk factor for cardiovascular disease, interfering with fibrinolysis and promoting atherosclerosis. Elevated Lp (a) indicates higher cardiovascular risk, especially when combined with other risk factors.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Genetics
Context:
- Arterial hypertension and coronary disease pathogenesis involve complex interactions between genetic predisposition and environmental factors.
- Lipoprotein (a) [Lp (a)], a subclass of LDL, is an understudied cardiovascular risk factor.
- Apolipoprotein (a) in Lp (a) shares structural similarities with plasminogen, influencing its physiological and pathophysiological roles.
Purpose:
- To explore the role of Lipoprotein (a) [Lp (a)] in the etiopathogenesis of arterial hypertension and coronary disease.
- To reevaluate the significance of cardiovascular risk factors, particularly Lp (a).
- To discuss the clinical significance and therapeutic implications of elevated Lp (a) levels.
Summary:
- Lp (a) interferes with fibrinolysis and promotes atherothrombosis by competing with plasminogen.
- Elevated Lp (a) levels are genetically determined and associated with increased risk of myocardial infarction.
- Lp (a) contributes to atherosclerosis by inhibiting fibrinolysis, promoting smooth muscle cell proliferation, and facilitating foam cell formation.
- Prospective studies and meta-analyses confirm Lp (a) as a significant cardiovascular risk factor, especially in individuals with existing risk factors.
Impact:
- Elevated Lp (a) identifies individuals at increased cardiovascular risk, necessitating closer monitoring and potentially tailored therapeutic strategies.
- Routine Lp (a) determination may be beneficial for specific patient groups, including those with early cardiovascular events or family history.
- While Lp (a) levels are not directly modifiable by current therapies, managing other risk factors like hypertension and dyslipidemia is crucial.
- Further research is needed to establish effective Lp (a)-targeted therapies, though some interventions like aspirin and B vitamins may offer benefits.