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Nutrition et cardiovasculaire

Lipoprotein(a)

Genetically determined lipoprotein particle associated with increased cardiovascular risk.

Definition

A lipoprotein particle composed of LDL and apolipoprotein(a). Independent genetic risk factor for atherosclerosis and thrombosis.

How it works

Lp(a) is a variant of LDL where apolipoprotein B100 is linked to apo(a) by a disulfide bond. Unlike other lipoproteins, Lp(a) levels are primarily determined genetically and little influenced by dietary regimen or usual medications. Lp(a) favors both atherosclerosis and thrombosis (clot formation), increasing the risk of heart attack and stroke. Elevated Lp(a) levels are a major independent risk factor even with normal cholesterol levels.

Role

Increases the risk of atherosclerosis and thrombosis through pro-inflammatory and pro-coagulant mechanisms.

Examples

  • Elevated Lp(a) levels despite controlled LDL-C
  • Family history of premature infarction
  • Levels above 50 mg/dL (>125 nmol/L)

Recommendations

Have Lp(a) tested at least once in life, particularly with a family history of cardiovascular disease. For high levels, consider specific treatments (asopcimab, inclisiran) in consultation with a cardiologist.

Key takeaway

Lp(a) is a powerful genetic risk factor justifying aggressive management of the overall lipid profile.

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