Lipoprotein(a)

Povišen Lp(a) je nasljedni, neovisni i uzročni rizični čimbenik za pojavu ASKVB-a¹

Što je lipoprotein (a)? Lp(a) je pro-aterogeni, pro-inflamatorni i pro-trombotski lipoprotein.^6,7

Povišen Lp(a) nalazi se kod 1 u 5 osoba u svijetu³

Epidemiološke i genetske studije pokazale su povezanost između povišenog Lp(a) i povećanog rizika za razvoj ASKVB-a.⁶ Podatci sugeriraju da je Lp(a) najjači neovisni genetski čimbenik rizika i za infarkt miokarda (MI) i za aortalnu stenozu, te je u obrnutoj korelaciji s očekivanim životnim vijekom.¹

Kako izgleda Lp(a)

Lp(a) je LDL čestica kovalentno vezana za apo(a) protein preko njegove apoB komponente. Smatra se vrlo „ljepljivom“ lipoproteinskom česticom zbog funkcije dodanog proteina.⁶

Lp(a) i kardiovaskularni rizik

Važnost i jednostavnost određivanja Lp(a): 

• Određivanje Lp(a) može identificirati bolesnike koji ostaju u riziku unatoč terapiji za snižavanje LDL-K⁸
• Određivanje Lp(a) poboljšava predviđanje i klasifikaciju KV rizika^4,9,10
• Mjerenje razine Lp(a) preporučuje se jednom u životu bolesnika, kao dio početnog probira za procjenu KV rizika^4,11,12*
• Potrebna je jednostavna krvna pretraga¹⁰

*Preporučuje se jednom u životu svake osobe

Određivanje Lp(a) - Brošura za liječnike

Preuzmite brošuru

Smjernice obično preporučuju prag za Lp(a) >50 mg/dL kao vrijednost koja upućuje na povećani KV rizik.^13,14

DOKAZI IZ KLINIČKE PRAKSE

Podatci i analize o lipoproteinu(a) iz kliničke prakse.

Karakteristike bolesnika s određenim Lp(a) – analiza databaze zdravstvenog osiguranja

Preuzmite sadržaj

 

Procjena iz kliničke prakse distribucije razina lipida kod povećanih razina lipoproteina(a) u bolesnika s ustanovljenom kardiovaskularnom bolesti u SAD-u

Preuzmite sadržaj

Lp(a) misteriozni čimbenik ateroskleroze

Živjeti s povišenim lipoproteinom(a)
Što bolesnik treba znati ako ima povišen lipoprotein(a) ili ste mu nedavno dijagnosticirali povišen lipoprotein(a) možete naći u brošuri. 

Za Vaše bolesnike

Na ovom dijelu internetske stranice www.klubzdravlja.hr pronaći ćete nepromotivni medicinski sadržaj namijenjen isključivo zdravstvenim radnicima na području Republike Hrvatske.

KRATICE:

ASKVB, aterosklerotska kardiovaskularna bolest; KV, kardiovaskularni; LDL, lipoprotein niske gustoće; LDL-K, kolesterol u lipoproteinima niske gustoće; Lp(a), lipoprotein(a)

LITERATURA:

1. McNeal CJ, Peterson AL. Lipoprotein (a) in Youth. [Updated 2020 Feb 9]. In: Feingold KR, Anawalt B, Boyce A et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Dostupno na: https://www.ncbi.nlm.nih.gov/books/NBK395570/. 
2. McNeal CJ. Lipoprotein(a): Its relevance to the pediatric population. J Clin Lipidol. 2015;9(5 Suppl): S57‒S66. 
3. Thanassoulis G. Screening for high lipoprotein(a) – the time is now. Circulation. 2019;139(12):1493‒1496. 
4. Mach F, Baigent C, Catapano AL i sur. ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020 Jan 1;41(1):111-188. 
5. Cegla J, Neely RDG, France M, Ferns G, Byrne CD, Halcox J i sur. HEART UK consensus statement on Lipoprotein(a): A call to action Atherosclerosis. 2019;291:62‒70.
6. Tsimikas S, Fazio S, Ferdinand KC, Ginsberg HN, Koschinsky ML, Marcovina SM i sur. Unmet Needs in Understanding Lipoprotein(a) Pathophysiology: NHLBI Working Group Recommendations to Reduce Risk of Cardiovascular Disease and Aortic Stenosis J Am Coll Cardiol. 2018;71(2):177‒192. 
7. Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies. J Am Coll Cardiol. 2017;69:692–711. 
8. Willeit P, Ridker PM, Nestel PJ, Simes J, Tonkin AM, Pedersen TR, Schwartz GG, Olsson AG, Colhoun HM, Kronenberg F, Drechsler C, Wanner C, Mora S, Lesogor A, Tsimikas S. Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials. Lancet. 2018 Oct 13;392(10155):1311-1320. doi: 10.1016/S0140-6736(18)31652-0. Epub 2018 Oct 4. PMID: 30293769. 
9. Willeit P, Kiechl S, Kronenberg F, Witztum JL, Santer P, Mayr M i sur. Discrimination and net reclassification of cardiovascular risk with lipoprotein(a): prospective 15-year outcomes in the Bruneck Study. J Am Coll Cardiol. 2014;64(9):851–860.
10. Wilson DP, Jacobson AJ, Jones PH, Koschinsky ML, McNeal CJ, Nordestgaard BG i sur. Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019;13(3):374–392. 
11. Piepoli MF, Hoes WF, Agewall S, Albus C, Brotons C, Catapano AL,  Cooney M i sur. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J. 2016;37(29):2315–2381. 
12. Pearson GJ, Thanassoulis G, Anderson TJ, Barry RA, Couture P, Dayan N i sur. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiol. 2021 Aug;37(8):1129-1150. DOI: https://doi.org/10.1016/j.cjca.2021.03.016.
13. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ i sur. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Circulation. 2019;140(11):e596–e646. 
14. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, i sur. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–e1143."