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Published on: October 12, 2017
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Lipoprotein(a) and cardiovascular disease
Børge G Nordestgaard1, Anne Langsted1
1Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Lancet (London, England)
|September 15, 2024
Summary
High lipoprotein(a) increases cardiovascular risk. Lifetime measurement of lipoprotein(a) can guide lifestyle and medication for high-risk individuals, with promising new drugs in development.
Area of Science:
- Cardiology
- Genetics
- Epidemiology
Background:
- High lipoprotein(a) affects 1 in 5 people, increasing risk for atherosclerotic cardiovascular disease and aortic valve stenosis.
- Lipoprotein(a) levels exhibit significant ethnic and sex-based variations, with concentrations being genetically determined.
- Current management focuses on lifestyle and other risk factor reduction due to lack of approved therapies targeting lipoprotein(a).
Purpose of the Study:
- To provide a comprehensive review of lipoprotein(a) in cardiovascular disease.
- To discuss the genetic, epidemiological, and clinical aspects of lipoprotein(a).
- To explore current and future therapeutic strategies for lowering lipoprotein(a).
Main Methods:
- Review of historical perspectives, physiology, pathophysiology, and genetic evidence.
- Analysis of epidemiological data on lipoprotein(a) concentrations across diverse populations.
- Examination of the role of lipoprotein(a) in familial hypercholesterolemia and diabetes.
- Assessment of current management, screening, diagnosis, and prevention strategies.
- Evaluation of emerging lipoprotein(a)-lowering drugs in clinical trials.
Main Results:
- Lipoprotein(a) concentrations are lowest in East/Southeast Asians and Europeans, intermediate in South Asians/Middle Easterners/Latin Americans, and highest in Africans.
- Concentrations are over 90% genetically determined and 17% higher in post-menopausal women than men.
- Numerous drugs in development show potential to significantly lower lipoprotein(a) by 65-98%.
Conclusions:
- Lifetime screening of lipoprotein(a) is recommended for individuals at high cardiovascular risk.
- Early detection and risk factor management are crucial for individuals with elevated lipoprotein(a).
- Emerging therapies hold significant promise for directly reducing lipoprotein(a) and mitigating cardiovascular risk.
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