[Lipoprotein(a): importance for the fibrinolytic system and thromboembolic complications]

Lipoprotein(a) has been pre-occupying cardiovascular scientists since 1963. The pathogenic significance of the lipoprotein(a) molecule (Figure 1) with regard to the development of arteriosclerosis and coronary heart disease gained increasing recognition during the 1970s, as has its negative influence on the endothelial fibrinolytic system over the past 15 years. Although the importance of lipoprotein(a) for the fibrinolytic system has not been adequately assessed hitherto in the majority of cardiologic studies, it is, in fact, precisely this negative influence, that constitutes the actual risk for thrombotic complications in the cardiovascular system as a whole. However, the true risk factor seems to be a low isoform of apo(a). These patient groups, who can nowadays be accurately defined by means of molecular biological studies, may possibly constitute an at-risk population that can be protected from further thrombotic complications. This article sets out to examine the copious evidence for further proatherogenic and prothrombotic properties of lipoprotein(a) (Figure 2) and discuss the molecular and pathophysiological mechanisms in the critical stage in early atherogenesis and thrombosis.