[New data about lipoprotein(a): a curious molecule or a causal cardiovascular risk factor?]

Lipoprotein(a) is of interest to both basic researchers as well as to clinicians who are involved in the contribution of Lp(a) to cardiovascular risk profiles. The Lp(a) particle is a hybrid molecule consisting of a half part indistinguable from circulating LDL linked to the unique glycoprotein component apolipoprotein(a). Many epidemiological data indicate that elevated Lp(a) levels are an independent risk factor for vascular disease. Apo(a) is highly homologous to the fibrinolytic plasminogen containing many repeated kringle motifs similar to several of those found in the plasminogen molecule. The size of the kringle domain in apo(a) gives rise to Lp(a) isoforms heterogeneity which is a hallmark of this lipoprotein. The similarity between Lp(a) and plasminogen led to speculation of a bridging role for Lp(a) in atherosclerosis and thrombosis mechanisms based on the double structure of this lipoprotein. Moreover, there are specific properties that apo(a) confers to Lp(a) : this include the ability of Lp(a) to affect platelet function and to contribute to endothelial dysfunction. Recently, new data have revealed a potential role for Lp(a) in the elimination of oxidized phospholipids. Future areas of development in this field include the role of apo(a) isoform size as a risk factor, the possible physiological roles of Lp(a), as well as recommendations for the best treatment of elevated Lp(a) in clinical practice.