Lipoprotein(a): Koronare Herzerkrankung - klinische Bedeutung und Therapieoptionen

Seit der Erstbeschreibung von Lipoprotein(a) (Lp(a)) beschäftigt sich die kardiovaskuläre Forschung mit der Frage, wie dieses Molekül sowohl atherogene als auch thrombogene Prozesse beeinflusst. Aufgrund der Vielzahl der Anfragen von Patienten mit Lp(a)-Erhöhung und koronarer Herzerkrankung (KHK) zur Apherese-Therapie oder zu Alternativen ist es notwendig, wissenschaftlich und medizinisch Antworten auf die Frage nach Therapiemöglichkeiten erhöhter Lp(a)-Konzentrationen zu suchen. Seit den 70er Jahren erkannte man zunehmend den pathogenen Einfluss des Lp(a)-Moleküls auf die Entstehung der Arteriosklerose und der KHK. Darüber hinaus wurde in den letzten 15 Jahren auch die negative Bedeutung von Lp(a) für das endotheliale fibrinolytische System beschrieben. Gerade der negative Einfluss auf die Fibrinolyse in Kombination mit der LDL-ähnlichen, arteriosklerotischen Wirkung ist das eigentliche Risiko für atherothrombotische (und spontane) Komplikationen im gesamten kardiovaskulären System und sollte in verstärktem Maße die Forschung beschäftigen. Dabei repräsentiert die Subpopulation der Patienten mit einer kleineren Isoform des apo(a)-Anteils des Lp(a) eine Risikogruppe, die z. B. mittels Immunadsorptionsapherese oder lebenslanger verstärkter Antikoagulation vor weiteren Komplikationen geschützt werden könnte. Die klinische Bedeutung des Lp(a) und die therapeutischen Möglichkeiten werden vor dem Hintergrund der vorliegenden Studien diskutiert.

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