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JCL roundtable-Lipoprotein(a): The emerging risk factor.

Santica M Marcovina¹, Patrick M Moriarty², Marlys L Koschinsky³

¹University of Washington, Seattle, WA, USA.

Journal of Clinical Lipidology

|December 12, 2018

Summary

Lipoprotein(a) (Lp(a)) is a key risk factor for cardiovascular events and calcific aortic stenosis. Emerging therapies show promise in significantly lowering Lp(a) levels, offering new clinical strategies.

Keywords:

Atherothrombosis Calcific aortic stenosis Cardiovascular risk Childhood stroke Lipoprotein(a)

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Area of Science:

Cardiovascular Medicine
Genetics
Pharmacology

Background:

Lipoprotein(a) (Lp(a)) is a significant risk factor for atherothrombotic events, comparable to LDL cholesterol.
Lp(a) is implicated in the progression of calcific aortic stenosis and arterial strokes, even without atherosclerosis.
Understanding Lp(a) inheritance and apolipoprotein(a) structure-function is advancing.

Purpose of the Study:

To review the role of Lipoprotein(a) in cardiovascular diseases.
To explore the interaction between Lp(a), oxidized phospholipids, and inflammatory markers.
To discuss novel pharmaceutical strategies for Lp(a) reduction and clinical management.

Main Methods:

Review of current literature on Lp(a) genetics, function, and clinical impact.
Discussion of recent findings on Lp(a) interactions with inflammatory pathways.
Analysis of emerging antisense and RNA interference technologies for Lp(a) lowering.

Main Results:

Lp(a) levels are strongly inherited, with apolipoprotein(a) structure influencing function.
Interactions between oxidized phospholipids on Lp(a) and interleukin-1 genotypes are observed.
New therapies, including antisense and RNA interference, can reduce Lp(a) by up to 90%.

Conclusions:

Lipoprotein(a) is a critical, actionable target for cardiovascular risk reduction.
Novel therapeutic approaches offer unprecedented potential for lowering Lp(a) levels.
Clinical measurement and management strategies for Lp(a) are evolving.