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Molecular, Population, and Clinical Aspects of Lipoprotein(a): A Bridge Too Far?

1
School of Public Health, Curtin University, Perth 6102, Australia
2
School of Medicine, University of Western Australia, Perth 6009, Australia
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Department of Cardiology, Mater Hospital, Brisbane 4104, Australia
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School of Medicine University of Queensland, Brisbane 4072, Australia
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Medical School, The University of Sydney, Sydney 2006, Australia
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Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
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Department of Biochemistry, Royal Prince Alfred Hospital, Sydney 2050, Australia
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Baker Heart & Diabetes Institute, Melbourne 3004, Australia
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Department of Cardiology, The Alfred Hospital, Melbourne 3004, Australia
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Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth 6000, Australia
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2073; https://doi.org/10.3390/jcm8122073
Received: 29 October 2019 / Revised: 15 November 2019 / Accepted: 15 November 2019 / Published: 27 November 2019
(This article belongs to the Special Issue Developing Novel Therapies to Prevent Atherosclerosis)
There is now significant evidence to support an independent causal role for lipoprotein(a) (Lp(a)) as a risk factor for atherosclerotic cardiovascular disease. Plasma Lp(a) concentrations are predominantly determined by genetic factors. However, research into Lp(a) has been hampered by incomplete understanding of its metabolism and proatherogeneic properties and by a lack of suitable animal models. Furthermore, a lack of standardized assays to measure Lp(a) and no universal consensus on optimal plasma levels remain significant obstacles. In addition, there are currently no approved specific therapies that target and lower elevated plasma Lp(a), although there are recent but limited clinical outcome data suggesting benefits of such reduction. Despite this, international guidelines now recognize elevated Lp(a) as a risk enhancing factor for risk reclassification. This review summarises the current literature on Lp(a), including its discovery and recognition as an atherosclerotic cardiovascular disease risk factor, attempts to standardise analytical measurement, interpopulation studies, and emerging therapies for lowering elevated Lp(a) levels. View Full-Text
Keywords: lipoprotein(a); atherosclerotic cardiovascular disease; calcific aortic valve disease lipoprotein(a); atherosclerotic cardiovascular disease; calcific aortic valve disease
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Ward, N.C.; Kostner, K.M.; Sullivan, D.R.; Nestel, P.; Watts, G.F. Molecular, Population, and Clinical Aspects of Lipoprotein(a): A Bridge Too Far? J. Clin. Med. 2019, 8, 2073.

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