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Lipoprotein(a): Pathophysiology, measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA)

Vincent Durlach 1, 2 Dominique Bonnefont-Rousselot 3, 4 Franck Boccara 5, 6, 7 Mathilde Varret 8, 9 Mathilde Di-Filippo Charcosset 10, 11 Bertrand Cariou 12, 13 René Valero 14, 15 Sybil Charriere 11, 10 Michel Farnier 16, 17 Pierre Morange 15 Olivier Meilhac 18, 19, 20 Gilles Lambert 18, 19, 20 Philippe Moulin 11, 10 Philippe Gillery 2, 21 Sophie Beliard-Lasserre 14, 15 Eric Bruckert 3, 6 Alain Carrié 6, 3 Jean Ferrières 22, 23 Xavier Collet 24, 23 M. John Chapman 3 Eduardo Anglés-Cano 25
Abstract : Lipoprotein(a) is an apolipoprotein B100-containing low-density lipoprotein-like particle that is rich in cholesterol, and is associated with a second major protein, apolipoprotein(a). Apolipoprotein(a) possesses structural similarity to plasminogen but lacks fibrinolytic activity. As a consequence of its composite structure, lipoprotein(a) may: (1) elicit a prothrombotic/antifibrinolytic action favouring clot stability; and (2) enhance atherosclerosis progression via its propensity for retention in the arterial intima, with deposition of its cholesterol load at sites of plaque formation. Equally, lipoprotein(a) may induce inflammation and calcification in the aortic leaflet valve interstitium, leading to calcific aortic valve stenosis. Experimental, epidemiological and genetic evidence support the contention that elevated concentrations of lipoprotein(a) are causally related to atherothrombotic risk and equally to calcific aortic valve stenosis. The plasma concentration of lipoprotein(a) is principally determined by genetic factors, is not influenced by dietary habits, remains essentially constant over the lifetime of a given individual and is the most powerful variable for prediction of lipoprotein(a)-associated cardiovascular risk. However, major interindividual variations (up to 1000-fold) are characteristic of lipoprotein(a) concentrations. In this context, lipoprotein(a) assays, although currently insufficiently standardized, are of considerable interest, not only in stratifying cardiovascular risk, but equally in the clinical follow-up of patients treated with novel lipid-lowering therapies targeted at lipoprotein(a) (e.g. antiapolipoprotein(a) antisense oligonucleotides and small interfering ribonucleic acids) that markedly reduce circulating lipoprotein(a) concentrations. We recommend that lipoprotein(a) be measured once in subjects at high cardiovascular risk with premature coronary heart disease, in familial hypercholesterolaemia, in those with a family history of coronary heart disease and in those with recurrent coronary heart disease despite lipid-lowering treatment. Because of its clinical relevance, the cost of lipoprotein(a) testing should be covered by social security and health authorities.
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Submitted on : Monday, November 29, 2021 - 12:22:27 AM
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Arch CardioVasc Diseases 2021....
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Vincent Durlach, Dominique Bonnefont-Rousselot, Franck Boccara, Mathilde Varret, Mathilde Di-Filippo Charcosset, et al.. Lipoprotein(a): Pathophysiology, measurement, indication and treatment in cardiovascular disease. A consensus statement from the Nouvelle Société Francophone d’Athérosclérose (NSFA). Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2021, pp.S1875-2136(21)00186-8. ⟨10.1016/j.acvd.2021.10.009⟩. ⟨inserm-03453934⟩

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