Lipoprotein(a): Pathophysiology, measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

Durlach, V.; Bonnefont‐Rousselot, Dominique; Boccara, Franck; Varret, Mathilde; Charcosset, Mathilde; Cariou, Bertrand; Valéro, René; Charrière, Sybil; Farnier, Michel; Morange, Pierre‐Emmanuel; Meilhac, Olivier; Lambert, Gilles; Moulin, Philippe; Gillery, Philippe; Béliard-Lasserre, Sophie; Bruckert, Éric; Carrié, Alain; Ferrières, Jean; Collet, Xavier; Chapman, M. John; Anglès-Cano, Eduardo

doi:10.1016/j.acvd.2021.10.009

Cited by 14 publications

(4 citation statements)

References 193 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, apo(a) protein is encoded by the LPA gene in the long arm of chromosome 6 within region 6q2.6-2.7, so it is a conserved protein (26) with steady production rate that is only affected by liver diseases (27) and not by statin therapy (28) . In support of these assumptions, Deconinck et al (29) The reported concomitant elevations of Lp(a) and t-PA levels could be attributed to the homology of the LPA gene with the human plasminogen gene (30) and the presence of a domain of inactive serineprotease, whose amino acid sequence in Apo(a) coincides with that of plasminogen in 94%, but serine replaced arginine in the activation site equivalent to that of plasminogen, thus hinders the conversion of Lp(a) into active protease by t-PA responsible for activation (31) . These structural similarities between Lp(a) and plasminogen lead to the interference with the fibrinolytic cascade despite the increased levels of t-PA and account for the atherogenic mechanism of Lp(a) (32,30) .…”

Section: Roc Curve Analysis Defined High Levels Ofmentioning

confidence: 93%

Estimation of serum levels of Lipoprotein(a) might help to resolve the dilemma of differentiation between Unstable Angina and Non-ST-elevation Myocardial Infarction

Elian

Mohammed

Marei

2023

Benha Medical Journal

View full text Add to dashboard Cite

Objectives: Evaluation of the performance of estimated serum levels of lipoprotein(a) [Lp(a)] and tissue plasminogen activator (t-PA) in the discrimination between patients presenting by cardiac events. Patients & Methods: 314 patients presenting with a clinical picture suggestive of an acute cardiac event (ACE) underwent clinical and laboratory workup according to the 2017 ESC Guidelines for the management of acute myocardial infarction (AMI). Blood samples were obtained for ELISA estimation of serum Lp(a) and plasma t-PA levels. Results: Clinically, 247 patients had angina, 166 stable angina (SA), 81 unstable angina (UA), 67 patients had AMI, 44 had non-ST-elevation MI (NSTEMI) and 23 patients had STEMI. Serum levels of Lp(a)were significantly higher in total patients' samples especially UA and MI patients compared to control samples, but were lower in those with compared to patients' samples. Further, Lp(a) levels were significantly higher in MI than UA patients' samples. Estimated t-PA levels were significantly higher in patients' than control samples, but were significantly higher in MI than angina patients' samples. Statistical analyses defined high estimated levels of Lp(a), t-PA, total cholesterol, and obesity as the significant differentiating variables between SA and UA patients and defined high levels of LP(a), t-PA, and obesity, and age as the significant predictors for NSTEMI. Conclusion: Elevated serum levels of Lp(a) might differentiate between UA patients and SA and NSTEMI with high specificity.

show abstract

Section: Roc Curve Analysis Defined High Levels Ofmentioning

confidence: 93%

Estimation of serum levels of Lipoprotein(a) might help to resolve the dilemma of differentiation between Unstable Angina and Non-ST-elevation Myocardial Infarction

Elian

Mohammed

Marei

2023

Benha Medical Journal

View full text Add to dashboard Cite

show abstract

“…The EAS expert panel recommends more intensive CV risk management in those with high Lp(a) concentrations and a high baseline risk [ 66 ]. It is recommended that Lp(a) levels are measured at least once in individuals with diabetes to personalise the CV risk estimation [ 66 , 67 ]. To date, there is no effective and recommended therapy targeting Lp(a).…”

Section: Therapies Mainly Targeting Lipoprotein (A)mentioning

confidence: 99%

Hyperlipidaemia in diabetes: are there particular considerations for next-generation therapies?

Béliard,

Mourre,

Valéro

2024

Diabetologia

View full text Add to dashboard Cite

Dyslipidaemias are major cardiovascular risk factors, especially in people with diabetes. In this area, next-generation therapies targeting circulating lipoparticle metabolism (LDL, VLDL, chylomicrons, HDL) have recently been approved by the European and US medical agencies, including anti- proprotein convertase subtilisin/kexin 9 (PCSK9) antibodies; an siRNA targeting PCSK9; bempedoic acid, which targets ATP citrate lyase; an antisense oligonucleotide targeting apolipoprotein C-III; an anti-angiopoietin-like 3 antibody; and a purified omega-3 fatty acid, icosapent ethyl. Other therapies are in different phases of development. There are several important considerations concerning the link between these new lipid-lowering therapies and diabetes. First, since concerns were first raised in 2008 about an increased risk of new-onset diabetes mellitus (NODM) with intensive statin treatment, each new lipid-lowering therapy is being evaluated for its associated risk of NODM, particularly in individuals with prediabetes (impaired fasting glucose and/or impaired glucose tolerance). Second, people with diabetes represent a large proportion of those at high or very high cardiovascular risk in whom these lipid-lowering drugs are currently, or will be, prescribed. Thus, the efficacy of these drugs in subgroups with diabetes should also be closely considered, as well as any potential effects on glycaemic control. In this review, we describe the efficacy of next-generation therapies targeting lipoprotein metabolism in subgroups of people with diabetes and their effects on glycaemic control in individuals with diabetes and prediabetes and in normoglycaemic individuals. Graphical Abstract

show abstract

“…Several lines of evidence suggest that large absolute reductions in Lp(a) concentrations of ~100 mg/dL are needed to achieve meaningful reductions in ASCVD risk [ 7 , 112 , 113 ]. Therefore, only those drugs that are specifically designed for the purpose of Lp(a)-lowering could be expected to have beneficial effects on ASCVD outcomes.…”

Section: Lp(a)-lowering Therapiesmentioning

confidence: 99%

Effects of Lipid-Modifying and Other Drugs on Lipoprotein(a) Levels—Potent Clinical Implications

et al. 2023

View full text Add to dashboard Cite

The past few years have shown an ongoing interest in lipoprotein(a) (Lp(a)), a lipid molecule that has been proven to have atherogenic, thrombogenic, and inflammatory properties. Several lines of evidence, indeed, have demonstrated an increased risk of cardiovascular disease as well as calcific aortic valve stenosis in patients with elevated Lp(a) levels. Statins, the mainstay of lipid-lowering therapy, slightly increase Lp(a) levels, while most other lipid-modifying agents do not significantly alter Lp(a) concentrations, except for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The latter have been shown to reduce Lp(a) levels; however, the clinical significance of this effect has not been clearly elucidated. Of note, the pharmaceutical lowering of Lp(a) may be achieved with novel treatments specifically designed for this purpose (i.e., antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs)). Large clinical trials with cardiovascular outcomes with these agents are ongoing, and their results are eagerly awaited. Furthermore, several non-lipid-modifying drugs of various classes may influence Lp(a) concentrations. We have searched MEDLINE, EMBASE, and CENTRAL databases up to 28 January 2023 and summarized the effects of established and emerging lipid-modifying drugs and other medications on Lp(a) levels. We also discuss the potent clinical implications of these alterations.

show abstract

Lipoprotein(a): Pathophysiology, measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

Cited by 14 publications

References 193 publications

Estimation of serum levels of Lipoprotein(a) might help to resolve the dilemma of differentiation between Unstable Angina and Non-ST-elevation Myocardial Infarction

Estimation of serum levels of Lipoprotein(a) might help to resolve the dilemma of differentiation between Unstable Angina and Non-ST-elevation Myocardial Infarction

Hyperlipidaemia in diabetes: are there particular considerations for next-generation therapies?

Effects of Lipid-Modifying and Other Drugs on Lipoprotein(a) Levels—Potent Clinical Implications

Contact Info

Product

Resources

About