Related Experiment Videos
Lipoprotein Lp(a) excess and coronary heart disease
1Section of Cardiology, University of Wisconsin Medical School, Madison, USA.
Insights
Elevated Lipoprotein Lp(a) levels predict early vascular disease. This review details screening and treatment strategies for managing Lipoprotein Lp(a) excess to reduce cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Atherosclerosis Research
Background:
- Lipoprotein Lp(a) excess is a significant risk factor for premature atherosclerotic vascular disease.
- Elevated Lp(a) levels are common in individuals with premature coronary atherosclerosis and hypercholesterolemia.
- Lp(a) contributes to atherothrombosis via impaired fibrinolysis, enhanced cholesterol deposition, and oxidized LDL.
Purpose of the Study:
- To provide an evidence-based approach to screening and treating patients with elevated Lipoprotein Lp(a).
- To address the role of Lp(a) in premature coronary heart disease and atherothrombosis.
Main Methods:
- Review of large, prospective studies identifying Lp(a) as a predictor of vascular disease.
- Analysis of mechanisms by which Lp(a) contributes to atherothrombosis.
- Evaluation of current treatment strategies focusing on LDL cholesterol reduction.
Main Results:
- Lipoprotein Lp(a) excess is a powerful predictor of premature atherosclerotic vascular disease.
- Lp(a) influences coronary heart disease risk in hypercholesterolemia.
- Multiple mechanisms link Lp(a) to atherothrombotic risk.
Conclusions:
- Specific therapy targeting Lp(a) may be necessary for high-risk patients.
- Screening and treatment of Lp(a) excess are crucial for managing premature coronary atherosclerosis.
- An evidence-based approach is essential for optimal patient management.
Abstract:
Lipoprotein Lp(a) excess has been identified as a powerful predictor of premature atherosclerotic vascular disease in several large, prospective studies. Lipoprotein Lp(a) levels modulate the risk of coronary heart disease in patients with hypercholesterolemia, and lipoprotein Lp(a) excess is commonly detected in men and women with premature coronary atherosclerosis. Lipoprotein Lp(a) contributes to atherothrombotic risk by multiple mechanisms that include impaired fibrinolysis, increased cholesterol deposition in the arterial wall, and enhanced oxidation of low density lipoprotein cholesterol. Although low density lipoprotein cholesterol reduction is the primary intervention in patients with lipoprotein Lp(a) excess, specific therapy to lower lipoprotein Lp(a) may be indicated for patients with premature coronary atherosclerosis, a strong family history of premature atherosclerosis, or refractory hypercholesterolemia. In consideration of the high prevalence of lipoprotein Lp(a) excess in patients with premature coronary heart disease and the intricate role of lipoprotein Lp(a) in atherothrombosis, this review provides an evidence-based approach to the screening and treatment of patients with lipoprotein Lp(a) excess.