Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

作者：Florian Kronenberg, Samia Mora, Erik S.G. Stroes, Brian A. Ference, Benoît J. Arsenault, Lars Berglund, Marc R. Dweck, Marlys L. Koschinsky, Gilles Lambert, François Mach, Catherine J. McNeal, Patrick M. Moriarty, Pradeep Natarajan, Børge G. Nordestgaard, Klaus G. Parhofer, Salim S. Virani, Arnold von Eckardstein, Gerald F. Watts, Jane K. Stock, Kausik K. Ray, Lâle Tokgözoğlu, Alberico L. Catapano · 发表于：European Heart Journal · 年份：2022 · DOI：10.1093/eurheartj/ehac361 · 被引用次数：1435 · 研究领域：Lipoproteins and Cardiovascular Health、Antiplatelet Therapy and Cardiovascular Diseases、Acute Myocardial Infarction Research

This 2022 European Atherosclerosis Society lipoprotein(a) [Lp(a)] consensus statement updates evidence for the role of Lp(a) in atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis, provides clinical guidance for testing and treating elevated Lp(a) levels, and considers its inclusion in global risk estimation. Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes in different ethnicities; elevated Lp(a) is a risk factor even at very low levels of low-density lipoprotein cholesterol. High Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. Current findings do not support Lp(a) as a risk factor for venous thrombotic events and impaired fibrinolysis. Very low Lp(a) levels may associate with increased risk of diabetes mellitus meriting further study. Lp(a) has pro-inflammatory and pro-atherosclerotic properties, which may partly relate to the oxidized phospholipids carried by Lp(a). This panel recommends testing Lp(a) concentration at least once in adults; cascade testing has potential value in familial hypercholesterolaemia, or with family or personal history of (very) high Lp(a) or premature ASCVD. Without specific Lp(a)-lowering therapies, early intensive risk factor management is recommended, targeted according to global cardiovascular risk and Lp(a) level. Lipoprotein apheresis is ...