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Lipoprotein(a) and cardiovascular risk: A roadmap for patient management

Lp (a), cardiovascular risk and patient management

Alberico L. Catapano
Department of Pharmacological and Biomolecular Sciences, University of Milan and Centre for the Study of Atherosclerosis, IRCCS MultiMedica, Milan
Pasquale Perrone Filardi
Department of Advanced Biomedical Sciences, University 'Federico II', Naples, Italy
Fabrizio Oliva
U.O.C. Cardiology 1-Emodinamics, Cardiothoracovascular Department 'A. De Gasperis', ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Luisa Agnello
Institute of Clinical Biochemistry, Clinical Molecular Biology and Clinical Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
Andrea Baragetti
Department of Pharmacological and Biomolecular Sciences, University of Milan and Centre for the Study of Atherosclerosis, IRCCS MultiMedica, Milan, Italy
Martina Berteotti
Department of Experimental and Clinical Medicine, University of Florence, Italy
Claudio Bilato
U.O.C. Cardiology, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza, Italy
Paolo Calabrò
Cardiovascular Department, U.O.C. Cardiology Clinic, A.O.R.N. Sant'Anna e San Sebastiano, Caserta and Department of Translational Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
Arturo Cesaro
Cardiovascular Department, U.O.C. Cardiology Clinic, A.O.R.N. Sant'Anna e San Sebastiano, Caserta and Department of Translational Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
Anna Maria Gori
Department of Experimental and Clinical Medicine, University of Florence, Italy
Rossella Marcucci | Bio
Department of Experimental and Clinical Medicine, University of Florence and S.O.D. Atherothrombotic Diseases, A. O. U. Careggi, Florence, Italy
Marcello Ciaccio
Institute of Clinical Biochemistry, Clinical Molecular Biology and Clinical Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo and Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo., Italy
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Abstract

Lipoprotein(a) [Lp(a)] is a plasma lipoprotein that shares structural elements with low-density lipoprotein (LDL), such as apolipoprotein B-100 (apoB), but differs by the presence of apolipoprotein(a) [apo(a)], which is covalently linked to apoB via a disulphide bond. In recent years, interest in Lp(a) has increased considerably, as epidemiological, genetic and biological evidence supports its causal role in cardiovascular disease. Its heterogeneous structural features, metabolic peculiarities, and ability to transport biologically active and potentially pro- atherogenic, pro-inflammatory and pro-thrombotic molecules make Lp(a) a unique lipoprotein among the apoB-containing lipoproteins.
Lp(a) is now recognised as an important risk factor in cardiovascular risk assessment, as it plays a causal and independent role in the development of both atherosclerotic disease and aortic valve stenosis. Measuring Lp(a), together with other determinants of cardiovascular risk, is now recognised as essential for appropriate clinical management and the identification of new therapeutic targets. Consequently, the need to include Lp(a) in global cardiovascular risk assessment has clearly emerged, especially in individuals with a personal history of early or recurrent events, familial hypercholesterolaemia, family history of early events, or family history of high Lp(a) levels.
This document, produced through the collaboration of the main Italian scientific societies in the field of cardiovascular disease management and laboratory medicine (SISA, SIC, ANMCO and SIBioC), analyses the pathogenetic role of lipoprotein(a) [Lp(a)] and the clinical significance of its measurement.

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