Lipoprotein(a): Cardiovascular Disease, Aortic Stenosis and New Therapeutic Option

Abstract

Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.

Keywords: aortic stenosis; cardiovascular events; lipoprotein(a).

Figure 1

Lp(a) and plasminogen structural homology. K = Kringles (numbered from I to V); CT = C-Terminal; NT = N- Terminal; LBS = Lysine Binding Site.

Figure 2

Summary of the three main mechanisms of Lp(a) mediated cardiovascular damage. PLT = Platelets; PAI-1 = Plasminogen activator inhibitor type 1; TF = Tissue Factor.