Biomedicines (Jul 2021)

Lipoprotein(a) Where Do We Stand? From the Physiopathology to Innovative Terapy

  • Gabriella Iannuzzo,
  • Maria Tripaldella,
  • Vania Mallardo,
  • Mena Morgillo,
  • Nicoletta Vitelli,
  • Arcangelo Iannuzzi,
  • Emilio Aliberti,
  • Francesco Giallauria,
  • Anna Tramontano,
  • Raffaele Carluccio,
  • Ilenia Calcaterra,
  • Matteo Nicola Dario Di Minno,
  • Marco Gentile

DOI
https://doi.org/10.3390/biomedicines9070838
Journal volume & issue
Vol. 9, no. 7
p. 838

Abstract

Read online

A number of epidemiologic studies have demonstrated a strong association between increasing lipoprotein a [Lp(a)] and cardiovascular disease. This correlation was demonstrated independent of other known cardiovascular (CV) risk factors. Screening for Lp(a) in the general population is not recommended, although Lp(a) levels are predominantly genetically determined so a single assessment is needed to identify patients at risk. In 2019 ESC/EAS guidelines recommend Lp(a) measurement at least once a lifetime, fo subjects at very high and high CV risk and those with a family history of premature cardiovascular disease, to reclassify patients with borderline risk. As concerning medications, statins play a key role in lipid lowering therapy, but present poor efficacy on Lp(a) levels. Actually, treatment options for elevated serum levels of Lp(a) are very limited. Apheresis is the most effective and well tolerated treatment in patients with high levels of Lp(a). However, promising new therapies, in particular antisense oligonucleotides have showed to be able to significantly reduce Lp(a) in phase II RCT. This review provides an overview of the biology and epidemiology of Lp(a), with a view to future therapies.

Keywords