Lipoprotein Lp(a) Excess and Coronary Heart Disease

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.

Lipoprotein(a), type 2 diabetes and vascular risk in coronary patients

“…Of note, in subgroup analyses, we found that Lp(a) in the subgroup of nondiabetic patients using statins was not associated with vascular events, whereas it was strongly predictive of vascular events in nondiabetic patients who did not receive statins. Although statins do not considerably influence Lp(a) serum values, they very effectively lower LDL cholesterol [43]. Lp(a) is less strongly associated with vascular events when LDL cholesterol is low, and lowering LDL with statins might be an effective approach at decreasing the cardiovascular risk conferred by high Lp(a) [44].…”

Diabetes‐associated macrovasculopathy: pathophysiology and pathogenesis

“…By inhibiting fibrinolysis, increased levels of lipoprotein(a) potentially delay thrombolysis and contribute to plaque progression [87]. There is also an impaired attenuation of clot formation and fibrinolysis in the diabetic state [82][83][84][85][86][87][88][89].…”

Lipoprotein(a) Serum Levels and Vascular Diseases in an Older Caucasian Population Cohort

“…4 Elevated Lp(a) levels have been considered a risk factor for coronary and peripheral artery diseases. [5][6][7] However, one recent study failed to demonstrate an association between elevated Lp(a) levels and the risk of coronary artery disease in women aged Ն 55 years, 8 thus raising some doubt about the universal applicability of the results of previous studies that were mainly based on male and middle-aged subjects. [9][10][11][12][13][14][15][16][17][18][19][20] The role of elevated Lp(a) levels as a risk factor for cerebrovascular diseases is controversial.…”