Lipoprotein(a): a genetically determined risk factor for Cardiovascular disease.

IF 6.6 2区 医学 Q1 MEDICAL LABORATORY TECHNOLOGY Critical reviews in clinical laboratory sciences Pub Date : 2023-12-01 Epub Date: 2023-07-14 DOI:10.1080/10408363.2023.2229915
Santica M Marcovina
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Abstract

Lipoprotein(a) is a complex lipoprotein with unique characteristics distinguishing it from all the other apolipoprotein B-containing lipoprotein particles. Its lipid composition and the presence of a single molecule of apolipoprotein B per particle, render lipoprotein(a) similar to low-density lipoproteins. However, the presence of a unique, carbohydrate-rich protein termed apolipoprotein(a), linked by a covalent bond to apolipoprotein B imparts unique characteristics to lipoprotein(a) distinguishing it from all the other lipoproteins. Apolipoprotein(a) is highly polymorphic in size ranging in molecular weight from <300 KDa to >800 kDa. Both the size polymorphism and the concentration of lipoprotein(a) in plasma are genetically determined and unlike other lipoproteins, plasma concentration is minimally impacted by lifestyle modifications or lipid-lowering drugs. Many studies involving hundreds of thousands of individuals have provided strong evidence that elevated lipoprotein(a) is genetically determined and a causal risk factor for atherosclerotic cardiovascular disease. The concentration attained in adulthood is already present in children at around 5 years of age and therefore, those with elevated lipoprotein(a) are prematurely exposed to a high risk of cardiovascular disease. Despite the large number of guidelines and consensus statements on the management of lipoprotein(a) in atherosclerotic cardiovascular disease published in the last decade, lipoprotein(a) is still seldom measured in clinical settings. In this review, we provide an overview of the most important features that characterize lipoprotein(a), its role in cardiovascular disease, and the importance of adding the measurement of lipoprotein(a) for screening adults and youths to identify those at increased risk of atherosclerotic cardiovascular disease due to their elevated plasma concentration of lipoprotein(a).

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脂蛋白(a):基因决定的心血管疾病危险因素。
脂蛋白(a)是一种复杂的脂蛋白,具有独特的特征,区别于所有其他载脂蛋白b -含脂蛋白颗粒。它的脂质组成和每颗粒单个载脂蛋白B分子的存在,使脂蛋白(a)类似于低密度脂蛋白。然而,存在一种独特的富含碳水化合物的蛋白质,称为载脂蛋白(a),通过共价键与载脂蛋白B相连,赋予脂蛋白(a)独特的特征,使其区别于所有其他脂蛋白。载脂蛋白(a)在大小上具有高度多态性,分子量从800 kDa不等。血浆中脂蛋白(a)的大小多态性和浓度都是由基因决定的,与其他脂蛋白不同,血浆浓度受生活方式改变或降脂药物的影响最小。许多涉及数十万人的研究提供了强有力的证据,表明脂蛋白(a)升高是由遗传决定的,是动脉粥样硬化性心血管疾病的因果危险因素。成年期达到的浓度在5岁左右的儿童中已经存在,因此,脂蛋白(a)升高的儿童过早暴露于心血管疾病的高风险中。尽管在过去十年中发表了大量关于动脉粥样硬化性心血管疾病中脂蛋白(a)管理的指南和共识声明,但在临床环境中脂蛋白(a)仍然很少被测量。在这篇综述中,我们概述了表征脂蛋白(a)的最重要特征,它在心血管疾病中的作用,以及增加脂蛋白(a)测量的重要性,以筛选成人和青少年,以识别由于血浆脂蛋白浓度升高而增加动脉粥样硬化性心血管疾病风险(a)。
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来源期刊
CiteScore
20.00
自引率
0.00%
发文量
25
审稿时长
>12 weeks
期刊介绍: Critical Reviews in Clinical Laboratory Sciences publishes comprehensive and high quality review articles in all areas of clinical laboratory science, including clinical biochemistry, hematology, microbiology, pathology, transfusion medicine, genetics, immunology and molecular diagnostics. The reviews critically evaluate the status of current issues in the selected areas, with a focus on clinical laboratory diagnostics and latest advances. The adjective “critical” implies a balanced synthesis of results and conclusions that are frequently contradictory and controversial.
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