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Lipoprotein(a)

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Dyslipidemias

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Lipoprotein(a), Lp(a), a complex between a low-density lipoprotein (LDL)-like lipid moiety containing one copy of apolipoprotein (apo) B, and apo(a), a plasminogen-derived, carbohydrate-rich, hydrophilic protein, is a genetically regulated cardiovascular risk factor. While La(a) levels are stable within an individual, Lp(a) levels have a skewed distribution in the population and are strongly impacted by a size polymorphism of the LPA gene, resulting in a variable number of kringle IV (KIV) units, a key motif of apolipoprotein(a). The variation in KIV units is a strong predictor of plasma Lp(a) levels and has been associated with cardiovascular risk, as recently confirmed by Mendelian randomization studies. In view of a number of recent, large studies firmly documenting Lp(a) as a cardiovascular risk factor, the European Atherosclerosis Society has issued screening and treatment guidelines. To date, there is only limited experience from Lp(a)-reducing therapy, and apart from nicotinic acid, Lp(a) levels are not impacted by conventional lipid-lowering therapy. Recent studies using novel therapeutic approaches show promise, as apoB antisense inhibitors and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors have been shown to decrease Lp(a) levels, opening possibilities for intervention as well as mechanistic studies.

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Authors and Affiliations

  1. Department of Internal Medicine, UC Davis Medical Center, 2921 Stockton Blvd Suite 1400, 95817, Sacramento, CA, USA

    Prof. Erdembileg Anuurad MD, PhD & Prof. Lars Berglund MD, PhD

  2. Department of Internal Medicine, UC Davis School of Medicine, 451 East Health Sciences Drive, Genome and Biomedical Sciences Facility (GBSF), Suite 5404, 95616, Davis, CA, USA

    Prof. Byambaa Enkhmaa MD, PhD & Wei Zhang PhD

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  1. Prof. Byambaa Enkhmaa MD, PhD
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  2. Prof. Erdembileg Anuurad MD, PhD
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Correspondence to Lars Berglund MD, PhD .

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  1. Professor of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA

    Abhimanyu Garg

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Enkhmaa, B., Anuurad, E., Zhang, W., Berglund, L. (2015). Lipoprotein(a). In: Garg, A. (eds) Dyslipidemias. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-424-1_3

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