Lipoprotein(a)-60 Years Later-What Do We Know?

Area of Science:

• Cardiovascular Medicine
• Biochemistry
• Genetics

Background:

• Lipoprotein(a) (Lp(a)) is a primary plasma transporter of oxidized phospholipids (OxPL).
• Elevated Lp(a) levels are strongly associated with various atherosclerotic cardiovascular diseases (ASCVD), including stroke and peripheral arterial disease (PAD).
• Lp(a) concentration is primarily determined by LPA gene expression, with variations observed across different ethnicities and age groups.

Purpose of the Study:

• To review current scientific and clinical knowledge regarding Lipoprotein(a) (Lp(a)).
• To highlight challenges in diagnosing and managing Lp(a))-associated cardiovascular risk.
• To identify future research directions for effective Lp(a) risk management and level control.

Main Methods:

• Review of epidemiological, clinical, and in vitro studies.
• Analysis of current clinical practice challenges and knowledge gaps.
• Synthesis of recent research findings and future study recommendations.

Main Results:

• Lp(a)) is a significant, independent risk factor for ASCVD, calcific aortic valve disease/aortic stenosis (CAVD/AS), stroke, heart failure, and PAD.
• Clinical management is hindered by a lack of specific Lp(a))-lowering therapies and standardized diagnostic/risk assessment guidelines.
• Inter-individual variability in Lp(a) levels due to genetics, ethnicity, and age complicates risk stratification.

Conclusions:

• Despite established links to cardiovascular disease, effective clinical strategies for managing Lp(a)) remain underdeveloped.
• Standardization of Lp(a) assays and development of targeted therapies are crucial for improving patient outcomes.
• Further research is needed to refine risk assessment and develop effective interventions for elevated Lp(a)) levels.