Lipoprotein (a): Underrecognized Risk with a Promising Future

医学 PCSK9 生物标志物 前蛋白转化酶 临床试验 烟酸 血脂异常 可欣 药理学 脂蛋白(a) 不利影响 药品 内科学 脂蛋白 生物信息学 胆固醇 疾病 低密度脂蛋白受体 生物化学 生物
作者
Matteo Manzato,R. Scott Wright,Allan S. Jaffe,Vlad C. Vasile
出处
期刊:Reviews in Cardiovascular Medicine [IMR Press]
卷期号:25 (11)
标识
DOI:10.31083/j.rcm2511393
摘要

Lipoprotein a (Lp(a)) is a lipid biomarker that binds cholesterol and bears independent cardiovascular risk. Strategies to lower the level of Lp(a) and mitigate such risk are important both for primary and secondary prevention. Currently there are no approved therapies targeting Lp(a) directly. Lipid lowering therapies prescribed routinely may have no effect on Lp(a) levels. Some agents such as niacin and estrogens can significantly decrease Lp(a), but their use is not recommended due to their adverse safety profile. Statins increase Lp(a) levels by 10–20%, questioning the benefit of such therapy when this biomarker is elevated. The Food and Drug Administration (FDA) endorses new agents to address dyslipidemia such as proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9-i) and Inclisiran, a small interfering RNA. These approaches have been shown to also significantly reduce Lp(a), but more clinical data is needed before implementing their use in clinical practice. Clinical trials are currently ongoing to test the efficacy of newly developed antisense oligonucleotides and small interfering RNAs targeting the gene encoding for Lp(a) in hepatocytes, while other investigations assess small molecules that inhibit Lp(a) assembly. This review summarizes the pathophysiology and clinical implications of Lp(a) elevation, and focuses on proposed Lp(a) therapies and the current state of the clinical trials of such novel agents.
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