[Lipoprotein(a): Aspects of pathophysiology, epidemiology and treatment]

Lipoprotein(a) is an LDL-like particle disulfide-linked to apo(a). Plasma Lp(a) concentrations are mostly determined genetically. Apo(a) size polymorphism is inversely related to plasma Lp(a). Numerous studies had found Lp(a) or the apo(a)- polymorphism to have atherogenic and thrombogenic potential. There are some prospective trials which described significantly higher Lp(a)-levels in middle aged populations with cardiovascular events. Some studies found contrasting results; however, most of them have not been well designed or show methodological problems. Progress regarding effective therapeutic interventions has been slow and inadequate. This and lack of laboratory standardization explain why there are still hardly any interventional studies. In particularly severe cases, extracorporeal Lp(a) removal may be the only effective treatment option. Due the lack of prospective studies, this treatment option is not widely accepted in Germany yet.