Lipoprotein(a) as a cardiovascular risk factor: current status
Identifieur interne : 002292 ( PascalFrancis/Checkpoint ); précédent : 002291; suivant : 002293Lipoprotein(a) as a cardiovascular risk factor: current status
Auteurs : B Rge G. Nordestgaard [Danemark] ; M. John Chapman [France] ; Kausik Ray [Royaume-Uni] ; Jan Boren [Suède] ; Felicita Andreotti [Italie] ; Gerald F. Watts [Australie] ; Henry Ginsberg [États-Unis] ; Pierre Amarenco [France] ; Alberico Catapano [Italie] ; Olivier S. Descamps [Belgique] ; Edward Fisher [États-Unis] ; Petri T. Kovanen [Finlande] ; Jan Albert Kuivenhoven [Pays-Bas] ; Philippe Lesnik [France] ; Luis Masana [Espagne] ; Zeljko Reiner [Croatie] ; Marja-Riitta Taskinen [Finlande] ; Lale Tokgözoglu [Turquie] ; Anne Tybjaerg-Hansen [Danemark]Source :
- European heart journal [ 0195-668X ] ; 2010.
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Abstract
Aims 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. Methods The robust and specific association between elevated Lp(a) levels and increased cardiovascular disease (CVD)/cor-and results onary 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 hyperchotesterolaemia, 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). Conclusion 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.
Affiliations:
- Australie, Belgique, Croatie, Danemark, Espagne, Finlande, France, Italie, Pays-Bas, Royaume-Uni, Suède, Turquie, États-Unis
- Angleterre, Grand Londres, Hollande-Septentrionale, Latium, État de New York, Île-de-France
- Amsterdam, Londres, New York, Paris, Rome
- Université Columbia, Université d'Amsterdam, Université de Londres
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Lipoprotein(a) as a cardiovascular risk factor: current status</title><author><name sortKey="Nordestgaard, B Rge G" sort="Nordestgaard, B Rge G" uniqKey="Nordestgaard B" first="B Rge G." last="Nordestgaard">B Rge G. Nordestgaard</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen</s1><s2>2730 Herlev</s2><s3>DNK</s3><sZ>1 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>2730 Herlev</wicri:noRegion></affiliation></author><author><name sortKey="Chapman, M John" sort="Chapman, M John" uniqKey="Chapman M" first="M. John" last="Chapman">M. John Chapman</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>European Atherosclerosis Society, INSERM UMR-S939, Pitié-Salpetriere University Hospital</s1><s2>Paris 75651</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>75651</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Ray, Kausik" sort="Ray, Kausik" uniqKey="Ray K" first="Kausik" last="Ray">Kausik Ray</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>St George's University of London</s1><s2>London</s2><s3>GBR</s3><sZ>3 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">Université de Londres</orgName></affiliation></author><author><name sortKey="Boren, Jan" sort="Boren, Jan" uniqKey="Boren J" first="Jan" last="Boren">Jan Boren</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>University of Gothenburg</s1><s3>SWE</s3><sZ>4 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>University of Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Andreotti, Felicita" sort="Andreotti, Felicita" uniqKey="Andreotti F" first="Felicita" last="Andreotti">Felicita Andreotti</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Catholic University Medical School</s1><s2>Rome</s2><s3>ITA</s3><sZ>5 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Watts, Gerald F" sort="Watts, Gerald F" uniqKey="Watts G" first="Gerald F." last="Watts">Gerald F. Watts</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Western Australia</s1><s2>Perth</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>University of Western Australia</wicri:noRegion></affiliation></author><author><name sortKey="Ginsberg, Henry" sort="Ginsberg, Henry" uniqKey="Ginsberg H" first="Henry" last="Ginsberg">Henry Ginsberg</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Columbia University</s1><s2>New York</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Bichat University Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Catapano, Alberico" sort="Catapano, Alberico" uniqKey="Catapano A" first="Alberico" last="Catapano">Alberico Catapano</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Milan</s1><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>University of Milan</wicri:noRegion></affiliation></author><author><name sortKey="Descamps, Olivier S" sort="Descamps, Olivier S" uniqKey="Descamps O" first="Olivier S." last="Descamps">Olivier S. Descamps</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Hopital de Jolimont</s1><s2>Haine Saint-Paul</s2><s3>BEL</s3><sZ>10 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>Hopital de Jolimont</wicri:noRegion></affiliation></author><author><name sortKey="Fisher, Edward" sort="Fisher, Edward" uniqKey="Fisher E" first="Edward" last="Fisher">Edward Fisher</name><affiliation wicri:level="2"><inist:fA14 i1="11"><s1>New York University</s1><s2>New York</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Kovanen, Petri T" sort="Kovanen, Petri T" uniqKey="Kovanen P" first="Petri T." last="Kovanen">Petri T. Kovanen</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Wihuri Research Institute</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>12 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Wihuri Research Institute</wicri:noRegion></affiliation></author><author><name sortKey="Kuivenhoven, Jan Albert" sort="Kuivenhoven, Jan Albert" uniqKey="Kuivenhoven J" first="Jan Albert" last="Kuivenhoven">Jan Albert Kuivenhoven</name><affiliation wicri:level="4"><inist:fA14 i1="13"><s1>University of Amsterdam</s1><s3>NLD</s3><sZ>13 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region>Hollande-Septentrionale</region></placeName><orgName type="university">Université d'Amsterdam</orgName></affiliation></author><author><name sortKey="Lesnik, Philippe" sort="Lesnik, Philippe" uniqKey="Lesnik P" first="Philippe" last="Lesnik">Philippe Lesnik</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>European Atherosclerosis Society, INSERM UMR-S939, Pitié-Salpetriere University Hospital</s1><s2>Paris 75651</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Masana, Luis" sort="Masana, Luis" uniqKey="Masana L" first="Luis" last="Masana">Luis Masana</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Universitat Rovira & Virgili</s1><s2>Reus</s2><s3>ESP</s3><sZ>15 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Universitat Rovira & Virgili</wicri:noRegion></affiliation></author><author><name sortKey="Reiner, Zeljko" sort="Reiner, Zeljko" uniqKey="Reiner Z" first="Zeljko" last="Reiner">Zeljko Reiner</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>University Hospital Center Zagreb</s1><s3>HRV</s3><sZ>16 aut.</sZ></inist:fA14><country>Croatie</country><wicri:noRegion>University Hospital Center Zagreb</wicri:noRegion></affiliation></author><author><name sortKey="Taskinen, Marja Riitta" sort="Taskinen, Marja Riitta" uniqKey="Taskinen M" first="Marja-Riitta" last="Taskinen">Marja-Riitta Taskinen</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>Biomedicum</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>17 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Biomedicum</wicri:noRegion></affiliation></author><author><name sortKey="Tokgozoglu, Lale" sort="Tokgozoglu, Lale" uniqKey="Tokgozoglu L" first="Lale" last="Tokgözoglu">Lale Tokgözoglu</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>Hacettepe University</s1><s2>Ankara</s2><s3>TUR</s3><sZ>18 aut.</sZ></inist:fA14><country>Turquie</country><wicri:noRegion>Hacettepe University</wicri:noRegion></affiliation></author><author><name sortKey="Tybjaerg Hansen, Anne" sort="Tybjaerg Hansen, Anne" uniqKey="Tybjaerg Hansen A" first="Anne" last="Tybjaerg-Hansen">Anne Tybjaerg-Hansen</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>Rigshospitalet. University of Copenhagen</s1><s3>DNK</s3><sZ>19 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Rigshospitalet. University of Copenhagen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0028076</idno><date when="2010">2010</date><idno type="stanalyst">PASCAL 11-0028076 INIST</idno><idno type="RBID">Pascal:11-0028076</idno><idno type="wicri:Area/PascalFrancis/Corpus">002128</idno><idno type="wicri:Area/PascalFrancis/Curation">003D99</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">002292</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">002292</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Lipoprotein(a) as a cardiovascular risk factor: current status</title><author><name sortKey="Nordestgaard, B Rge G" sort="Nordestgaard, B Rge G" uniqKey="Nordestgaard B" first="B Rge G." last="Nordestgaard">B Rge G. Nordestgaard</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen</s1><s2>2730 Herlev</s2><s3>DNK</s3><sZ>1 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>2730 Herlev</wicri:noRegion></affiliation></author><author><name sortKey="Chapman, M John" sort="Chapman, M John" uniqKey="Chapman M" first="M. John" last="Chapman">M. John Chapman</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>European Atherosclerosis Society, INSERM UMR-S939, Pitié-Salpetriere University Hospital</s1><s2>Paris 75651</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>75651</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Ray, Kausik" sort="Ray, Kausik" uniqKey="Ray K" first="Kausik" last="Ray">Kausik Ray</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>St George's University of London</s1><s2>London</s2><s3>GBR</s3><sZ>3 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region><settlement type="city">Londres</settlement></placeName><orgName type="university">Université de Londres</orgName></affiliation></author><author><name sortKey="Boren, Jan" sort="Boren, Jan" uniqKey="Boren J" first="Jan" last="Boren">Jan Boren</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>University of Gothenburg</s1><s3>SWE</s3><sZ>4 aut.</sZ></inist:fA14><country>Suède</country><wicri:noRegion>University of Gothenburg</wicri:noRegion></affiliation></author><author><name sortKey="Andreotti, Felicita" sort="Andreotti, Felicita" uniqKey="Andreotti F" first="Felicita" last="Andreotti">Felicita Andreotti</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Catholic University Medical School</s1><s2>Rome</s2><s3>ITA</s3><sZ>5 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Watts, Gerald F" sort="Watts, Gerald F" uniqKey="Watts G" first="Gerald F." last="Watts">Gerald F. Watts</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>University of Western Australia</s1><s2>Perth</s2><s3>AUS</s3><sZ>6 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>University of Western Australia</wicri:noRegion></affiliation></author><author><name sortKey="Ginsberg, Henry" sort="Ginsberg, Henry" uniqKey="Ginsberg H" first="Henry" last="Ginsberg">Henry Ginsberg</name><affiliation wicri:level="4"><inist:fA14 i1="07"><s1>Columbia University</s1><s2>New York</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name><affiliation wicri:level="3"><inist:fA14 i1="08"><s1>Bichat University Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Catapano, Alberico" sort="Catapano, Alberico" uniqKey="Catapano A" first="Alberico" last="Catapano">Alberico Catapano</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>University of Milan</s1><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>University of Milan</wicri:noRegion></affiliation></author><author><name sortKey="Descamps, Olivier S" sort="Descamps, Olivier S" uniqKey="Descamps O" first="Olivier S." last="Descamps">Olivier S. Descamps</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Hopital de Jolimont</s1><s2>Haine Saint-Paul</s2><s3>BEL</s3><sZ>10 aut.</sZ></inist:fA14><country>Belgique</country><wicri:noRegion>Hopital de Jolimont</wicri:noRegion></affiliation></author><author><name sortKey="Fisher, Edward" sort="Fisher, Edward" uniqKey="Fisher E" first="Edward" last="Fisher">Edward Fisher</name><affiliation wicri:level="2"><inist:fA14 i1="11"><s1>New York University</s1><s2>New York</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Kovanen, Petri T" sort="Kovanen, Petri T" uniqKey="Kovanen P" first="Petri T." last="Kovanen">Petri T. Kovanen</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Wihuri Research Institute</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>12 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Wihuri Research Institute</wicri:noRegion></affiliation></author><author><name sortKey="Kuivenhoven, Jan Albert" sort="Kuivenhoven, Jan Albert" uniqKey="Kuivenhoven J" first="Jan Albert" last="Kuivenhoven">Jan Albert Kuivenhoven</name><affiliation wicri:level="4"><inist:fA14 i1="13"><s1>University of Amsterdam</s1><s3>NLD</s3><sZ>13 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Amsterdam</settlement><region>Hollande-Septentrionale</region></placeName><orgName type="university">Université d'Amsterdam</orgName></affiliation></author><author><name sortKey="Lesnik, Philippe" sort="Lesnik, Philippe" uniqKey="Lesnik P" first="Philippe" last="Lesnik">Philippe Lesnik</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>European Atherosclerosis Society, INSERM UMR-S939, Pitié-Salpetriere University Hospital</s1><s2>Paris 75651</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Masana, Luis" sort="Masana, Luis" uniqKey="Masana L" first="Luis" last="Masana">Luis Masana</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Universitat Rovira & Virgili</s1><s2>Reus</s2><s3>ESP</s3><sZ>15 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Universitat Rovira & Virgili</wicri:noRegion></affiliation></author><author><name sortKey="Reiner, Zeljko" sort="Reiner, Zeljko" uniqKey="Reiner Z" first="Zeljko" last="Reiner">Zeljko Reiner</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>University Hospital Center Zagreb</s1><s3>HRV</s3><sZ>16 aut.</sZ></inist:fA14><country>Croatie</country><wicri:noRegion>University Hospital Center Zagreb</wicri:noRegion></affiliation></author><author><name sortKey="Taskinen, Marja Riitta" sort="Taskinen, Marja Riitta" uniqKey="Taskinen M" first="Marja-Riitta" last="Taskinen">Marja-Riitta Taskinen</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>Biomedicum</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>17 aut.</sZ></inist:fA14><country>Finlande</country><wicri:noRegion>Biomedicum</wicri:noRegion></affiliation></author><author><name sortKey="Tokgozoglu, Lale" sort="Tokgozoglu, Lale" uniqKey="Tokgozoglu L" first="Lale" last="Tokgözoglu">Lale Tokgözoglu</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>Hacettepe University</s1><s2>Ankara</s2><s3>TUR</s3><sZ>18 aut.</sZ></inist:fA14><country>Turquie</country><wicri:noRegion>Hacettepe University</wicri:noRegion></affiliation></author><author><name sortKey="Tybjaerg Hansen, Anne" sort="Tybjaerg Hansen, Anne" uniqKey="Tybjaerg Hansen A" first="Anne" last="Tybjaerg-Hansen">Anne Tybjaerg-Hansen</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>Rigshospitalet. University of Copenhagen</s1><s3>DNK</s3><sZ>19 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Rigshospitalet. University of Copenhagen</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">European heart journal</title><title level="j" type="abbreviated">Eur. heart j.</title><idno type="ISSN">0195-668X</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">European heart journal</title><title level="j" type="abbreviated">Eur. heart j.</title><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Atherosclerosis</term><term>Cardiology</term><term>Cardiovascular disease</term><term>Circulatory system</term><term>Current</term><term>Lipids</term><term>Lipoprotein a</term><term>Myocardial infarction</term><term>Prevention</term><term>Risk factor</term><term>Stroke</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Athérosclérose</term><term>Pathologie de l'appareil circulatoire</term><term>Infarctus du myocarde</term><term>Accident cérébrovasculaire</term><term>Lipoprotéine a</term><term>Facteur risque</term><term>Courant</term><term>Lipide</term><term>Prévention</term><term>Appareil circulatoire</term><term>Cardiologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Aims 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. Methods The robust and specific association between elevated Lp(a) levels and increased cardiovascular disease (CVD)/cor-and results onary 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 hyperchotesterolaemia, 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). Conclusion 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.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0195-668X</s0></fA01><fA03 i2="1"><s0>Eur. heart j.</s0></fA03><fA05><s2>31</s2></fA05><fA06><s2>23</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Lipoprotein(a) as a cardiovascular risk factor: current status</s1></fA08><fA11 i1="01" i2="1"><s1>NORDESTGAARD (Børge G.)</s1></fA11><fA11 i1="02" i2="1"><s1>CHAPMAN (M. John)</s1></fA11><fA11 i1="03" i2="1"><s1>RAY (Kausik)</s1></fA11><fA11 i1="04" i2="1"><s1>BOREN (Jan)</s1></fA11><fA11 i1="05" i2="1"><s1>ANDREOTTI (Felicita)</s1></fA11><fA11 i1="06" i2="1"><s1>WATTS (Gerald F.)</s1></fA11><fA11 i1="07" i2="1"><s1>GINSBERG (Henry)</s1></fA11><fA11 i1="08" i2="1"><s1>AMARENCO (Pierre)</s1></fA11><fA11 i1="09" i2="1"><s1>CATAPANO (Alberico)</s1></fA11><fA11 i1="10" i2="1"><s1>DESCAMPS (Olivier S.)</s1></fA11><fA11 i1="11" i2="1"><s1>FISHER (Edward)</s1></fA11><fA11 i1="12" i2="1"><s1>KOVANEN (Petri T.)</s1></fA11><fA11 i1="13" i2="1"><s1>KUIVENHOVEN (Jan Albert)</s1></fA11><fA11 i1="14" i2="1"><s1>LESNIK (Philippe)</s1></fA11><fA11 i1="15" i2="1"><s1>MASANA (Luis)</s1></fA11><fA11 i1="16" i2="1"><s1>REINER (Zeljko)</s1></fA11><fA11 i1="17" i2="1"><s1>TASKINEN (Marja-Riitta)</s1></fA11><fA11 i1="18" i2="1"><s1>TOKGÖZOGLU (Lale)</s1></fA11><fA11 i1="19" i2="1"><s1>TYBJAERG-HANSEN (Anne)</s1></fA11><fA14 i1="01"><s1>Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, University of Copenhagen</s1><s2>2730 Herlev</s2><s3>DNK</s3><sZ>1 aut.</sZ></fA14><fA14 i1="02"><s1>European Atherosclerosis Society, INSERM UMR-S939, Pitié-Salpetriere University Hospital</s1><s2>Paris 75651</s2><s3>FRA</s3><sZ>2 aut.</sZ><sZ>14 aut.</sZ></fA14><fA14 i1="03"><s1>St George's University of London</s1><s2>London</s2><s3>GBR</s3><sZ>3 aut.</sZ></fA14><fA14 i1="04"><s1>University of Gothenburg</s1><s3>SWE</s3><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Catholic University Medical School</s1><s2>Rome</s2><s3>ITA</s3><sZ>5 aut.</sZ></fA14><fA14 i1="06"><s1>University of Western Australia</s1><s2>Perth</s2><s3>AUS</s3><sZ>6 aut.</sZ></fA14><fA14 i1="07"><s1>Columbia University</s1><s2>New York</s2><s3>USA</s3><sZ>7 aut.</sZ></fA14><fA14 i1="08"><s1>Bichat University Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="09"><s1>University of Milan</s1><s3>ITA</s3><sZ>9 aut.</sZ></fA14><fA14 i1="10"><s1>Hopital de Jolimont</s1><s2>Haine Saint-Paul</s2><s3>BEL</s3><sZ>10 aut.</sZ></fA14><fA14 i1="11"><s1>New York University</s1><s2>New York</s2><s3>USA</s3><sZ>11 aut.</sZ></fA14><fA14 i1="12"><s1>Wihuri Research Institute</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>12 aut.</sZ></fA14><fA14 i1="13"><s1>University of Amsterdam</s1><s3>NLD</s3><sZ>13 aut.</sZ></fA14><fA14 i1="14"><s1>Universitat Rovira & Virgili</s1><s2>Reus</s2><s3>ESP</s3><sZ>15 aut.</sZ></fA14><fA14 i1="15"><s1>University Hospital Center Zagreb</s1><s3>HRV</s3><sZ>16 aut.</sZ></fA14><fA14 i1="16"><s1>Biomedicum</s1><s2>Helsinki</s2><s3>FIN</s3><sZ>17 aut.</sZ></fA14><fA14 i1="17"><s1>Hacettepe University</s1><s2>Ankara</s2><s3>TUR</s3><sZ>18 aut.</sZ></fA14><fA14 i1="18"><s1>Rigshospitalet. University of Copenhagen</s1><s3>DNK</s3><sZ>19 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>European Atherosclerosis Society Consensus Panel</s1><s3>EUR</s3></fA17><fA20><s1>2844-2853</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>18785</s2><s5>354000193479630050</s5></fA43><fA44><s0>0000</s0><s1>© 2011 INIST-CNRS. All rights reserved.</s1></fA44><fA47 i1="01" i2="1"><s0>11-0028076</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>European heart journal</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Aims 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. Methods The robust and specific association between elevated Lp(a) levels and increased cardiovascular disease (CVD)/cor-and results onary 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 hyperchotesterolaemia, 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). Conclusion 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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B12B01</s0></fC02><fC02 i1="02" i2="X"><s0>002B12A03</s0></fC02><fC02 i1="03" i2="X"><s0>002B17C</s0></fC02><fC02 i1="04" i2="X"><s0>002B12A05</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Athérosclérose</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Atherosclerosis</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Ateroesclerosis</s0><s2>NM</s2><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Infarctus du myocarde</s0><s2>NM</s2><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Myocardial infarction</s0><s2>NM</s2><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Infarto miocardio</s0><s2>NM</s2><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Accident cérébrovasculaire</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Stroke</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Accidente cerebrovascular</s0><s5>04</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Lipoprotéine a</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Lipoprotein a</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Lipoproteina a</s0><s5>09</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Facteur risque</s0><s5>10</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Risk factor</s0><s5>10</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Factor riesgo</s0><s5>10</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Courant</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Current</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Corriente</s0><s5>11</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Lipide</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Lipids</s0><s5>12</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Lípido</s0><s5>12</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Prévention</s0><s5>13</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Prevention</s0><s5>13</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Prevención</s0><s5>13</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Appareil circulatoire</s0><s5>14</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Circulatory system</s0><s5>14</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Aparato circulatorio</s0><s5>14</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Cardiologie</s0><s5>15</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Cardiology</s0><s5>15</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Cardiología</s0><s5>15</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Pathologie des vaisseaux sanguins</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Vascular disease</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Vaso sanguíneo patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Cardiopathie coronaire</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Coronary heart disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Cardiopatía coronaria</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie du myocarde</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Myocardial disease</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Miocardio patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie cérébrovasculaire</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cerebrovascular disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Vaso sanguíneo encéfalo patología</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>42</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>43</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>43</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>43</s5></fC07><fN21><s1>017</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Croatie</li><li>Danemark</li><li>Espagne</li><li>Finlande</li><li>France</li><li>Italie</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Suède</li><li>Turquie</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Grand Londres</li><li>Hollande-Septentrionale</li><li>Latium</li><li>État de New York</li><li>Île-de-France</li></region><settlement><li>Amsterdam</li><li>Londres</li><li>New York</li><li>Paris</li><li>Rome</li></settlement><orgName><li>Université Columbia</li><li>Université d'Amsterdam</li><li>Université de Londres</li></orgName></list><tree><country name="Danemark"><noRegion><name sortKey="Nordestgaard, B Rge G" sort="Nordestgaard, B Rge G" uniqKey="Nordestgaard B" first="B Rge G." last="Nordestgaard">B Rge G. Nordestgaard</name></noRegion><name sortKey="Tybjaerg Hansen, Anne" sort="Tybjaerg Hansen, Anne" uniqKey="Tybjaerg Hansen A" first="Anne" last="Tybjaerg-Hansen">Anne Tybjaerg-Hansen</name></country><country name="France"><region name="Île-de-France"><name sortKey="Chapman, M John" sort="Chapman, M John" uniqKey="Chapman M" first="M. John" last="Chapman">M. John Chapman</name></region><name sortKey="Amarenco, Pierre" sort="Amarenco, Pierre" uniqKey="Amarenco P" first="Pierre" last="Amarenco">Pierre Amarenco</name><name sortKey="Lesnik, Philippe" sort="Lesnik, Philippe" uniqKey="Lesnik P" first="Philippe" last="Lesnik">Philippe Lesnik</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Ray, Kausik" sort="Ray, Kausik" uniqKey="Ray K" first="Kausik" last="Ray">Kausik Ray</name></region></country><country name="Suède"><noRegion><name sortKey="Boren, Jan" sort="Boren, Jan" uniqKey="Boren J" first="Jan" last="Boren">Jan Boren</name></noRegion></country><country name="Italie"><region name="Latium"><name sortKey="Andreotti, Felicita" sort="Andreotti, Felicita" uniqKey="Andreotti F" first="Felicita" last="Andreotti">Felicita Andreotti</name></region><name sortKey="Catapano, Alberico" sort="Catapano, Alberico" uniqKey="Catapano A" first="Alberico" last="Catapano">Alberico Catapano</name></country><country name="Australie"><noRegion><name sortKey="Watts, Gerald F" sort="Watts, Gerald F" uniqKey="Watts G" first="Gerald F." last="Watts">Gerald F. Watts</name></noRegion></country><country name="États-Unis"><region name="État de New York"><name sortKey="Ginsberg, Henry" sort="Ginsberg, Henry" uniqKey="Ginsberg H" first="Henry" last="Ginsberg">Henry Ginsberg</name></region><name sortKey="Fisher, Edward" sort="Fisher, Edward" uniqKey="Fisher E" first="Edward" last="Fisher">Edward Fisher</name></country><country name="Belgique"><noRegion><name sortKey="Descamps, Olivier S" sort="Descamps, Olivier S" uniqKey="Descamps O" first="Olivier S." last="Descamps">Olivier S. Descamps</name></noRegion></country><country name="Finlande"><noRegion><name sortKey="Kovanen, Petri T" sort="Kovanen, Petri T" uniqKey="Kovanen P" first="Petri T." last="Kovanen">Petri T. Kovanen</name></noRegion><name sortKey="Taskinen, Marja Riitta" sort="Taskinen, Marja Riitta" uniqKey="Taskinen M" first="Marja-Riitta" last="Taskinen">Marja-Riitta Taskinen</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Kuivenhoven, Jan Albert" sort="Kuivenhoven, Jan Albert" uniqKey="Kuivenhoven J" first="Jan Albert" last="Kuivenhoven">Jan Albert Kuivenhoven</name></region></country><country name="Espagne"><noRegion><name sortKey="Masana, Luis" sort="Masana, Luis" uniqKey="Masana L" first="Luis" last="Masana">Luis Masana</name></noRegion></country><country name="Croatie"><noRegion><name sortKey="Reiner, Zeljko" sort="Reiner, Zeljko" uniqKey="Reiner Z" first="Zeljko" last="Reiner">Zeljko Reiner</name></noRegion></country><country name="Turquie"><noRegion><name sortKey="Tokgozoglu, Lale" sort="Tokgozoglu, Lale" uniqKey="Tokgozoglu L" first="Lale" last="Tokgözoglu">Lale Tokgözoglu</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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