title: Lp(a) and cardiovascular risk: Investigating the hidden side of the moon.
abstract: This article reports current evidence on the association between Lp(a) and cardiovascular (CV) disease and on pathophysiological mechanisms. The available information on therapy for reduction of lipoprotein(a) is also discussed.
  
  
  
  Although some evidence is conflicting, Lp(a) seems to increase CV risk through stimulation of platelet aggregation, inhibition of tissue factor pathway inhibitor, alteration of fibrin clot structure and promotion of endothelial dysfunction and phospholipid oxidation. Lp(a) 3.5-fold higher than normal increases the risk of coronary heart disease and general CV events, particularly in those with LDL cholesterol ≥ 130 mg/dl. High Lp(a) values represent also an independent risk factor for ischemic stroke (more relevant in young stroke patients), peripheral artery disease (PAD) and aortic and mitral stenosis. Furthermore, high Lp(a) levels seem to be associated with increased risk of cardiovascular events in patients with chronic kidney disease, particularly in those undergoing percutaneous coronary intervention.
  
  
  
  Lipoprotein (a) (Lp[a]) seems to significantly influence the risk of cardiovascular events. The effects of statins and fibrates on Lp(a) are limited and extremely variable. Nicotinic acid was shown effective in reducing Lp(a) but, due to its side effects and serious adverse events during clinical trials, it is no longer considered a possible option for treatment. To date, the treatment of choice for high levels of Lp(a) in high CV risk patients is represented by LDL-Apheresis. Thanks to innovative technologies, new selectively inhibiting LPA drugs are being developed and tested.
authors: Regional Center for the Study of Atherosclerosis, Hypertension and Dyslipidemia, "SS Annunziata" Hospital - ASL Chieti, Italy; Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Italy.
authors: M
authors: M
authors: Bucci
authors: Internal Medicine Unit, Guastalla Hospital, AUSL Reggio Emilia, Italy.
authors: C
authors: C
authors: Tana
authors: Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Italy; Geriatrics Clinic, Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Italy.
authors: M A
authors: MA
authors: Giamberardino
authors: Regional Center for the Study of Atherosclerosis, Hypertension and Dyslipidemia, "SS Annunziata" Hospital - ASL Chieti, Italy; Ce.S.I.-Met, "G. D'Annunzio" University of Chieti, Italy; Geriatrics Clinic, Department of Medicine and Science of Aging, "G. D'Annunzio" University of Chieti, Italy. Electronic address: fcipollone@unich.it.
authors: F
authors: F
authors: Cipollone
mesh_terms: D015415:Biomarkers / Q000097:blood; D001781:Blood Component Removal; D001792:Blood Platelets / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D050171:Dyslipidemias / Q000097:blood / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D005337:Fibrin / Q000378:metabolism; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D010084:Oxidation-Reduction; D010743:Phospholipids / Q000097:blood; D010974:Platelet Aggregation; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D017270:Lipoprotein(a); D008074:Lipoproteins; D010743:Phospholipids; C051928:lipoprotein-associated coagulation inhibitor; D005337:Fibrin
keywords: Atherosclerosis; Cardiovascular risk; Ischemic heart disease; Lipoprotein (a); Niacin; Peripheral artery disease; Statins; Type 2 diabetes