CC BY-NC-ND 4.0 · Dtsch Med Wochenschr 2022; 147(23): 1564-1570
DOI: 10.1055/a-1516-2701
Übersicht

Lipoprotein(a)

Lp(a) and its role in cardiovascular diseases
Annika Reuser
,
Wolfgang Koenig
,
Ulrich Laufs

Lipoprotein(a), kurz Lp(a), ist ein wichtiger Marker für kardiovaskuläres Risiko. Die Lp(a)-Plasmakonzentration ist genetisch determiniert und kaum durch Ernährung, Bewegung oder aktuell verfügbare orale Medikamente modifiziert. Neue RNA-basierte spezifische Therapien sind in klinischer Entwicklung, allerdings wird es auch im Fall positiver Studienergebnisse noch Jahre dauern, bis diese Wirkstoffe breit zur Verfügung stehen. Daher stellen sich die Fragen, bei welchen Personen Lp(a) bestimmt und wie derzeit mit erhöhten Lp(a)-Werten umgegangen werden sollte.

Abstract

Lipoprotein(a) – Lp(a) – is an hepatically synthesized lipoprotein, structurally similar to low-density-lipoprotein, and an important marker for cardiovascular risk. Lp(a) plasma concentrations are genetically determined and can hardly be modified by diet, exercise or oral drugs. Lp(a) concentration should be tested at least once per life. The current treatment for high Lp(a) is early intensive risk factor management with optimal lowering of LDL-cholesterol. Potent new RNA-targeting therapies are currently assessed in clinical trials and may be available in a couple of years.



Publication History

Article published online:
02 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Literatur

  • 1 Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies. J Am Coll Cardiol 2017; 69: 692-711
  • 2 Kronenberg F, Mora S, Stroes ESG. et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J 2022; ehac361
  • 3 Langhammer R, Laufs U. Lipoprotein(a): Behandlung eines unterschätzten kardiovaskulären Risikomarkers. Aktuelle Kardiol 2020; 9: 370-375
  • 4 Lackner C, Boerwinkle E, Leffert CC. et al. Molecular basis of apolipoprotein (a) isoform size heterogeneity as revealed by pulsed-field gel electrophoresis. J Clin Invest 1991; 87: 2153-2161
  • 5 Yeang C, Witztum JL, Tsimikas S. Novel method for quantification of lipoprotein(a)-cholesterol: implications for improving accuracy of LDL-C measurements. J Lipid Res 2021; 62: 100053
  • 6 Gaubatz JW, Heideman C, Gotto AM. et al. Human plasma lipoprotein [a]. Structural properties. J Biol Chem 1983; 258: 4582-4589
  • 7 Wienbergen H, Rühle S, Osteresch R. et al. Lipoprotein (a): Aus kardiologischer Sicht zu wenig beachtet?. Dtsch Ärztebl 2021; 118: 16
  • 8 Cegla J, Neely RDG, France M. et al. HEART UK consensus statement on Lipoprotein(a): A call to action. Atherosclerosis 2019; 291: 62-70
  • 9 Willeit P, Ridker PM, Nestel PJ. et al. Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials. Lancet 2018; 392: 1311-1320
  • 10 Mach F, Baigent C, Catapano AL. et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41: 111-188
  • 11 Nordestgaard BG, Chapman MJ, Ray K. et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J 2010; 31: 2844-2853
  • 12 Raal FJ, Giugliano RP, Sabatine MS. et al. Reduction in lipoprotein(a) with PCSK9 monoclonal antibody evolocumab (AMG 145): a pooled analysis of more than 1,300 patients in 4 phase II trials. J Am Coll Cardiol 2014; 63: 1278-1288
  • 13 Ray KK, Vallejo-Vaz AJ, Ginsberg HN. et al. Lipoprotein(a) reductions from PCSK9 inhibition and major adverse cardiovascular events: Pooled analysis of alirocumab phase 3 trials. Atherosclerosis 2019; 288: 194-202
  • 14 Tsimikas S, Moriarty PM, Stroes ES. Emerging RNA Therapeutics to Lower Blood Levels of Lp(a): JACC Focus Seminar 2/4. J Am Coll Cardiol 2021; 77: 1576-1589
  • 15 Deutsche Gesellschaft für Nephrologie. Standard der therapeutischen Apherese. Im Internet (Stand: 19.09.2022): https://dgfn.eu/apherese-standard.html
  • 16 Katzmann JL, Packard CJ, Chapman MJ. et al. Targeting RNA With Antisense Oligonucleotides and Small Interfering RNA: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76: 563-579
  • 17 Tsimikas S, Karwatowska-Prokopczuk E, Gouni-Berthold I. et al. Lipoprotein(a) Reduction in Persons with Cardiovascular Disease. N Engl J Med 2020; 382: 244-255
  • 18 O’Donoghue MLG, López JA, Knusel B. et al. Study design and rationale for the Olpasiran trials of Cardiovascular Events And lipoproteiN(a) reduction-DOSE finding study (OCEAN(a)-DOSE). Am Heart J 2022; 251: 61-69