关于脂蛋白的共识和指南(a)——透过树木看到森林。

IF 3.8 3区 医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY Current opinion in lipidology Pub Date : 2022-12-01 Epub Date: 2022-10-14 DOI:10.1097/MOL.0000000000000855
Florian Kronenberg, Samia Mora, Erik S G Stroes
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引用次数: 0

摘要

回顾的目的:在过去的十年中,脂蛋白(a) [Lp(a)]形成了几个共识和指导文件。本综述旨在总结各种建议的基础文献,并比较最近欧洲和北美的共识和最近3-4年的指导文件。近期发现:多个大型流行病学和遗传学研究提供了强有力的证据,证明Lp(a)浓度与动脉粥样硬化性心血管疾病(ASCVD)和主动脉瓣狭窄之间存在因果关系。Lp(a)和ASCVD风险之间存在剂量依赖的线性关系,提倡在连续尺度上考虑Lp(a),而不是使用阈值。在临床中实现这一目标的最佳方法是使用“Lp(a)风险计算器”(http://www.lpaclinicalguidance.com)等工具对Lp(a)相关风险进行个体化,该工具考虑了个人传统风险因素和ASCVD全球风险背景下的Lp(a)水平。关于测量Lp(a)的临床应用,指南中越来越多的人达成了一致意见,最近的专家组提倡对所有成年人采用一般筛查方法。只要特定Lp(a)降低药物的心血管结局试验仍在进行中,目前对高Lp(a)患者的管理应侧重于对所有其他可改变的ASCVD危险因素的综合管理,这些危险因素可以根据指南建议进行治疗。摘要:由于高脂蛋白(a)浓度对全球ASCVD风险的贡献在过去被低估,因此明确建议在一个人的一生中至少测量一次脂蛋白(a)是必要的。在等待Lp(a)靶向治疗的临床试验结果的同时,最近的专家共识建议为临床医生提供了如何通过对可改变的ASCVD危险因素进行全面和个性化管理来管理与Lp(a)浓度升高相关的过度风险的指导。
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Consensus and guidelines on lipoprotein(a) - seeing the forest through the trees.

Purpose of the review: Over the past decade, lipoprotein(a) [Lp(a)] made it to several consensus and guideline documents. This review aims to summarize the literature which underlies the various recommendations and compares recent European and North American consensus and guideline documents of the recent 3-4 years.

Recent findings: Multiple large epidemiological and genetic studies have provided strong evidence for a causal association between Lp(a) concentrations and atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. There is a dose-dependent linear relationship between Lp(a) and ASCVD risk advocating to consider Lp(a) on a continuous scale rather than using thresholds. The best way to implement this in the clinic is by individualizing the Lp(a)-related risk using tools such as the 'Lp(a) risk calculator' ( http://www.lpaclinicalguidance.com ) that takes into account the Lp(a) level in the context of an individual's traditional risk factors and global risk for ASCVD. There is growing agreement across the guidelines regarding the clinical utility of measuring Lp(a) and more recent expert groups advocate for a general screening approach applied to all adults. As long as the cardiovascular outcomes trials for specific Lp(a)-lowering drugs are in progress, the current management of patients with high Lp(a) should focus on the comprehensive management of all other modifiable ASCVD risk factors which can be therapeutically addressed as per guideline recommendations.

Summary: Since the contribution of high Lp(a) concentrations to global ASCVD risk has been underestimated in the past, a clear recommendation to measure Lp(a) at least once in a person's lifetime is imperative. Recent expert consensus recommendations provide clinicians with direction on how to manage the excess risk associated with elevated Lp(a) concentration by comprehensive and individualized management of modifiable ASCVD risk factors while awaiting the results of clinical trials of Lp(a) targeted therapies.

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来源期刊
Current opinion in lipidology
Current opinion in lipidology 医学-内分泌学与代谢
CiteScore
6.70
自引率
4.50%
发文量
64
审稿时长
6-12 weeks
期刊介绍: With its easy-to-digest reviews on important advances in world literature, Current Opinion in Lipidology offers expert evaluation on a wide range of topics from six key disciplines including nutrition and metabolism, genetics and molecular biology, and hyperlipidaemia and cardiovascular disease. Published bimonthly, each issue covers in detail the most pertinent advances in these fields from the previous year. This is supplemented by a section of Bimonthly Updates, which deliver an insight into new developments at the cutting edge of the disciplines covered in the journal.
期刊最新文献
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