Lipoprotein(a) as a cardiovascular risk factor: current status
Identifieur interne : 000106 ( France/Analysis ); précédent : 000105; suivant : 000107Lipoprotein(a) as a cardiovascular risk factor: current status
Auteurs : Brge G. Nordestgaard [Danemark] ; M. John Chapman [France] ; Kausik Ray [Royaume-Uni] ; Jan Born [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 Tokgzoglu [Turquie] ; Anne Tybjrg-Hansen [Danemark]Source :
- European Heart Journal [ 0195-668X ] ; 2010-12.
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 and results 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 13 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.
Url:
DOI: 10.1093/eurheartj/ehq386
Affiliations:
- Australie, Belgique, Croatie, Danemark, Espagne, Finlande, France, Italie, Pays-Bas, Royaume-Uni, Suède, Turquie, États-Unis
- Angleterre, Grand Londres, Latium, État de New York, Île-de-France
- Londres, New York, Paris, Rome
- Université Columbia, Université de Londres
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Descamps</name><affiliation wicri:level="1"><country xml:lang="fr">Belgique</country><wicri:regionArea>Hopital de Jolimont, Haine Saint-Paul</wicri:regionArea><wicri:noRegion>Haine Saint-Paul</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"><country xml:lang="fr">États-Unis</country><wicri:regionArea>New York University, New York</wicri:regionArea><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"><country xml:lang="fr">Finlande</country><wicri:regionArea>Wihuri Research Institute, Helsinki</wicri:regionArea><wicri:noRegion>Helsinki</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="1"><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>University of Amsterdam</wicri:regionArea></affiliation></author><author><name sortKey="Lesnik, Philippe" sort="Lesnik, Philippe" uniqKey="Lesnik P" first="Philippe" last="Lesnik">Philippe Lesnik</name><affiliation wicri:level="3"><country xml:lang="fr">France</country><wicri:regionArea>European Atherosclerosis Society, INSERM UMR-S939, Piti-Salpetriere University Hospital, Paris 75651</wicri:regionArea><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"><country xml:lang="fr">Espagne</country><wicri:regionArea>Universitat Rovira & Virgili, Reus</wicri:regionArea><wicri:noRegion>Reus</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"><country xml:lang="fr">Croatie</country><wicri:regionArea>University Hospital Center Zagreb</wicri:regionArea></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"><country xml:lang="fr">Finlande</country><wicri:regionArea>Biomedicum, Helsinki</wicri:regionArea><wicri:noRegion>Helsinki</wicri:noRegion></affiliation></author><author><name sortKey="Tokgzoglu, Lale" sort="Tokgzoglu, Lale" uniqKey="Tokgzoglu L" first="Lale" last="Tokgzoglu">Lale Tokgzoglu</name><affiliation wicri:level="1"><country xml:lang="fr">Turquie</country><wicri:regionArea>Hacettepe University, Ankara</wicri:regionArea><wicri:noRegion>Ankara</wicri:noRegion></affiliation></author><author><name sortKey="Tybjrg Hansen, Anne" sort="Tybjrg Hansen, Anne" uniqKey="Tybjrg Hansen A" first="Anne" last="Tybjrg-Hansen">Anne Tybjrg-Hansen</name><affiliation wicri:level="1"><country xml:lang="fr">Danemark</country><wicri:regionArea>Rigshospitalet, University of Copenhagen</wicri:regionArea><wicri:noRegion>University of Copenhagen</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-12">2010-12</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">23</biblScope><biblScope unit="page" from="2844">2844</biblScope><biblScope unit="page" to="2853">2853</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">895558F69D4D2768A710408C3318A07B201733D7</idno><idno type="DOI">10.1093/eurheartj/ehq386</idno><idno type="href">ehq386.pdf</idno><idno type="ArticleID">ehq386</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="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 and results 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 13 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><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>Latium</li><li>État de New York</li><li>Île-de-France</li></region><settlement><li>Londres</li><li>New York</li><li>Paris</li><li>Rome</li></settlement><orgName><li>Université Columbia</li><li>Université de Londres</li></orgName></list><tree><country name="Danemark"><noRegion><name sortKey="Nordestgaard, Brge G" sort="Nordestgaard, Brge G" uniqKey="Nordestgaard B" first="Brge G." last="Nordestgaard">Brge G. Nordestgaard</name></noRegion><name sortKey="Nordestgaard, Brge G" sort="Nordestgaard, Brge G" uniqKey="Nordestgaard B" first="Brge G." last="Nordestgaard">Brge G. Nordestgaard</name><name sortKey="Tybjrg Hansen, Anne" sort="Tybjrg Hansen, Anne" uniqKey="Tybjrg Hansen A" first="Anne" last="Tybjrg-Hansen">Anne Tybjrg-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="Born, Jan" sort="Born, Jan" uniqKey="Born J" first="Jan" last="Born">Jan Born</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. 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