Lipoprotein(a) as a Causal Risk Factor for Cardiovascular Disease

Current Cardiovascular Risk Reports, Journal Year: 2025, Volume and Issue: 19(1)

Published: Feb. 18, 2025

Lipoprotein(a) [Lp(a)], an atherogenic low-density lipoprotein cholesterol (LDL-C)-like molecule, has emerged as important risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). This review summarizes evidence supporting Lp(a) a causal ASCVD and calcific aortic valve stenosis (CAVS). is largely (~ 90%) genetically determined approximately 20% global population elevated Lp(a). The unique structure leads to proatherogenic, proinflammatory, antifibrinolytic properties. Data from epidemiological, genome-wide association, Mendelian randomization, meta-analyses have shown clear association between ASCVD, well CAVS. There are emerging data on ischemic stroke, peripheral arterial disease, heart failure; however, associations not strong. Several lines support 2024 National Lipid Association guidelines, 2022 European Atherosclerosis Society, 2021 Canadian Cardiology Society guidelines recommend testing once in all adults guide primary prevention efforts. Further studies outcomes with targeted therapies will provide more insight relationship disease.

Language: Английский

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Leveraging drug-target Mendelian randomization for tailored lipoprotein-lipid lowering

Current Opinion in Lipidology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 20, 2025

Purpose of review The study naturally occurring genetic variation in human populations has laid the foundation for proprotein converts subtilisin/kexin type 9 inhibitors, and more recently new classes lipid-lowering drugs such as lipoprotein(a) inhibitors lipoprotein lipase pathway activators. These emerging therapies lower plasma lipoprotein-lipid levels that are not adequately managed by traditional low-density (LDL) cholesterol-lowering medications. By targeting different risk factors, these could help manage important residual cardiovascular LDL cholesterol Recent findings We latest insights into pharmacological modulation therapeutic targets. highlight remarkably recapitulate lipid effects observed studies. In addition to lowering levels, robust evidence support may prevent cardiometabolic outcomes. Summary Emerging launch a era preventive medicine which treatments optimally tailored patient's profiles.

Language: Английский

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Synergistic effects of lipoprotein (a) and fibrinogen on carotid plaque in patients with coronary artery disease

European journal of medical research, Journal Year: 2025, Volume and Issue: 30(1)

Published: Feb. 24, 2025

Elevated lipoprotein (a) [Lp (a)] and fibrinogen (Fib) are important factors contributing to the pathogenesis of atherosclerosis. Carotid plaque is a manifestation carotid atherosclerosis, previous studies have shown that Fib has synergistic effect on Lp (a)-induced events. However, combined action not been elucidated. This was cross-sectional study screened total 3913 patients who attended First Affiliated Hospital Xinjiang Medical University with confirmed diagnosis coronary artery disease (CAD) ultrasonography during 2019–2024. General clinical information, physical examination data, laboratory tests were collected from patients. Based results ultrasonography, divided into group (1123 cases) without (2790 cases). Multifactorial logistic regression analysis used explore correlation between levels interrelationship them. A included, including 2666 males 1247 females, incidence 28.7%, significant differences in two groups (P < 0.05) interaction effect. Multiple showed for every tenfold increase plasma (i.e., an one logarithmic unit), could by about 32% or so. After stratified age sex, it observed significantly associated men aged 60 years (male: OR = 1.301, 95% CI 1.051–1.611; years: 1.373, 1.076–1.753). Plasma different sexes groups, there (Pinteraction 0.05). independent risk disease, both plaque. Therefore, should be focused better treatment prevention ischemic stroke.

Language: Английский

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Evolving concepts of low‐density lipoprotein: From structure to function

European Journal of Clinical Investigation, Journal Year: 2025, Volume and Issue: unknown

Published: March 5, 2025

Low-density lipoprotein (LDL) is a central player in atherogenesis and has long been referred to as 'bad cholesterol.' However, emerging evidence indicates that LDL functions multifaceted ways beyond cholesterol transport include roles inflammation, immunity, cellular signaling. Understanding LDL's structure, metabolism function essential for advancing cardiovascular disease research therapeutic strategies. This narrative review examines the history, structural properties, of health disease. We analyze key milestones research, from its early identification recent advancements molecular biology omics-based investigations. Structural functional insights are explored through imaging, proteomic analyses lipidomic profiling, providing deeper understanding heterogeneity. metabolism, biosynthesis receptor-mediated clearance, plays crucial role lipid homeostasis atherogenesis. Beyond transport, contributes plaque modulates adaptive immunity regulates signaling pathways. studies reveal heterogeneous composition, which influences pathogenic potential. Evolving perspectives on redefine clinical significance, affecting risk assessment interventions. A holistic challenges traditional underscores complexity health. Future should focus further elucidating diversity refine prediction models strategies, ultimately improving outcomes.

Language: Английский

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Schlagen Frauenherzen anders? – Geschlechterunterschiede im Lipidmanagement

Deleted Journal, Journal Year: 2025, Volume and Issue: unknown

Published: March 10, 2025

Zusammenfassung Geschlechterspezifische Unterschiede im Lipidstoffwechsel sind vor allem hormonell bedingt. Frauen haben prämenopausal Vergleich zu Männern tendenziell günstigere Lipidwerte, wie höhere Konzentrationen an High-Density-Lipoprotein-Cholesterin (HDL-C) und niedrigere Low-Density-Lipoprotein-Cholesterin (LDL-C). Mit Beginn der Menopause verschlechtern sich diese Werte jedoch durch hormonelle Veränderungen, wodurch bei das Risiko für atherosklerotische Herz-Kreislauf-Erkrankungen erhöht. Trotz vergleichbarer Wirksamkeit lipidsenkender Therapien zeigen mehrere Studien einheitlich, dass seltener die empfohlenen LDL-C-Zielwerte erreichen. Besonders in klinischen Praxis bestehen große Diskrepanzen zwischen Leitlinienempfehlungen tatsächlicher Behandlung, Hochrisikopatientinnen. Verschiedene Barrieren tragen wesentlich dazu bei: Dazu gehören Unterschätzung des Risikos behandelnde Ärzte, ein zurückhaltenderes Verordnungsverhalten, eingeschränktes Bewusstsein Notwendigkeit einer Therapie Patientinnen sowie eine verminderte Medikamentenadhärenz. Letztere wird unter anderem stärkere Wahrnehmung von Nebenwirkungen Prävalenz Statinintoleranz beeinflusst. Die Betreuung spezialisierten Lipidzentren zeigt, viele schwer einstellbare Patienten, z. B. Patienten mit oder hohen LDL-C-Ausgangswerten, gezielter Nachsorge erfolgreich behandelt werden können. Neue pharmakologische Ansätze Kombinationstherapien ermöglichen es, Therapieziele Dennoch erreichen trotz solcher Maßnahmen ihre LDL-Zielwerte, was auf intensiverer geschlechtersensibler Strategien hinweist. Eine wirksame Lipidtherapie erfordert verstärkt den Einsatz Kombinationstherapien, regelmäßige Kontrollen enge Zusammenarbeit Patient Arzt. ist es entscheidend, Therapieadhärenz verbessern mögliche konsequent anzugehen, um kardiovaskuläre effektiv senken.

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