Lipoprotein(a) as a cardiovascular risk factor: current status.
Lipoprotein(a) as a cardiovascular risk factor: current status.
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DOI：
10.1093/eurheartj/ehq386
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发表时间：
2010-12
影响因子：
39.3
通讯作者：
European Atherosclerosis Society Consensus Panel
中科院分区：
文献类型：
--
作者：
Nordestgaard BG;Chapman MJ;Ray K;Borén J;Andreotti F;Watts GF;Ginsberg H;Amarenco P;Catapano A;Descamps OS;Fisher E;Kovanen PT;Kuivenhoven JA;Lesnik P;Masana L;Reiner Z;Taskinen MR;Tokgözoglu L;Tybjærg-Hansen A;European Atherosclerosis Society Consensus Panel
该研究的目的是，首先，严格评估脂蛋白（a）[Lp（a）]作为心血管危险因素，其次，建议筛查血浆Lp（a）升高，理想水平和治疗策略。Lp（a）水平升高与心血管疾病（CVD）/冠心病（CHD）风险增加之间的强有力和特异性关联，以及最近的遗传学发现，表明Lp（a）升高与LDL-胆固醇升高一样，与早发CVD/CHD有因果关系。这种关联是连续的，没有阈值或依赖于LDL或非HDL胆固醇水平。从机制上讲，升高的Lp（a）水平可能诱导促血栓形成/抗纤维蛋白溶解作用，因为载脂蛋白（a）类似于纤溶酶原和纤溶酶，但没有纤维蛋白溶解活性，或者可能加速动脉粥样硬化，因为像LDL一样，Lp（a）颗粒富含胆固醇，或者两者兼而有之。我们建议，对于具有中或高CVD/CHD风险的受试者，使用亚型不敏感测定法测量一次Lp（a），这些受试者患有早发CVD、家族性高胆固醇血症、早发CVD和/或Lp（a）升高的家族史、尽管接受他汀类药物治疗但仍复发的CVD、根据欧洲指南，10年致死性CVD风险≥3%，和/或根据美国指南，致死性+非致死性CHD的10年风险≥10%。作为LDL-胆固醇降低后的第二优先事项，我们建议Lp（a）<第80百分位数的理想水平（低于1050 mg/dL）。治疗应主要是烟酸1-3 g/天，因为随机对照干预试验的荟萃分析表明烟酸治疗可降低CVD。在极端情况下，LDL单采术可有效清除Lp（a）。我们建议在中等或高CVD/CHD风险的人群中筛查升高的Lp（a），理想水平<50 mg/dL作为全球心血管风险的函数，并使用烟酸降低Lp（a）和CVD/CHD风险。
The aims of the study were, first, to critically evaluate lipoprotein(a) [Lp(a)] as a cardiovascular risk factor and, second, to advise on screening for elevated plasma Lp(a), on desirable levels, and on therapeutic strategies. The robust and specific association between elevated Lp(a) levels and increased cardiovascular disease (CVD)/coronary heart disease (CHD) risk, together with recent genetic findings, indicates that elevated Lp(a), like elevated LDL-cholesterol, is causally related to premature CVD/CHD. The association is continuous without a threshold or dependence on LDL- or non-HDL-cholesterol levels. Mechanistically, elevated Lp(a) levels may either induce a prothrombotic/anti-fibrinolytic effect as apolipoprotein(a) resembles both plasminogen and plasmin but has no fibrinolytic activity, or may accelerate atherosclerosis because, like LDL, the Lp(a) particle is cholesterol-rich, or both. We advise that Lp(a) be measured once, using an isoform-insensitive assay, in subjects at intermediate or high CVD/CHD risk with premature CVD, familial hypercholesterolaemia, a family history of premature CVD and/or elevated Lp(a), recurrent CVD despite statin treatment, ≥3% 10-year risk of fatal CVD according to European guidelines, and/or ≥10% 10-year risk of fatal + non-fatal CHD according to US guidelines. As a secondary priority after LDL-cholesterol reduction, we recommend a desirable level for Lp(a) <80th percentile (less than ∼50 mg/dL). Treatment should primarily be niacin 1–3 g/day, as a meta-analysis of randomized, controlled intervention trials demonstrates reduced CVD by niacin treatment. In extreme cases, LDL-apheresis is efficacious in removing Lp(a). We recommend screening for elevated Lp(a) in those at intermediate or high CVD/CHD risk, a desirable level <50 mg/dL as a function of global cardiovascular risk, and use of niacin for Lp(a) and CVD/CHD risk reduction.
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影响因子：
15.9
作者：
Boonmark, NW;Lou, XJ;Lawn, RM
通讯作者：
Lawn, RM
影响因子：
120.7
作者：
Erqou, Sebhat;Kaptoge, Stephen;Perry, Philip L.;Di Angelantonio, Emanuele;Thompson, Alexander;White, Ian R.;Marcovina, Santica M.;Collins, Rory;Thompson, Simon G.;Danesh, John
通讯作者：
Danesh, John
影响因子：
10.4
作者：
Feric, N. T.;Boffa, M. B.;Koschinsky, M. L.
通讯作者：
Koschinsky, M. L.
影响因子：
24
作者：
Erqou, Sebhat;Thompson, Alexander;Danesh, John
通讯作者：
Danesh, John
DOI：
10.1016/s0735-1097(97)00528-7
发表时间：
1998-03-01
影响因子：
24
作者：
Cantin, B;Gagnon, F;Dagenais, GR
通讯作者：
Dagenais, GR