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The irruption of lipoprotein(a) (Lp(a)) in the study of cardiovascular risk factors is perhaps, together with the discovery and use of proprotein convertase subtilisin/kexin type 9 (iPCSK9) inhibitor drugs, the greatest novelty in the field for decades. Lp(a) concentration (especially very high levels) has an undeniable association with certain cardiovascular complications, such as atherosclerotic vascular disease (AVD) and aortic stenosis. However, there are several current limitations to both establishing epidemiological associations and specific pharmacological treatment. Firstly, the measurement of Lp(a) is highly dependent on the test used, mainly because of the characteristics of the molecule. Secondly, Lp(a) concentration is more than 80% genetically determined, so that, unlike other cardiovascular risk factors, it cannot be regulated by lifestyle changes. Finally, although there are many promising clinical trials with specific drugs to reduce Lp(a), currently only iPCSK9 (limited for use because of its cost) significantly reduces Lp(a). However, and in line with other scientific societies, the SEA considers that, with the aim of increasing knowledge about the contribution of Lp(a) to cardiovascular risk, it is relevant to produce a document containing the current status of the subject, recommendations for the control of global cardiovascular risk in people with elevated Lp(a) and recommendations on the therapeutic approach to patients with elevated Lp(a)., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

OBJETIVO: Avaliar níveis de lipoproteína(a) em pacientes com síndrome antifosfolípide primária (SAFP) e suas possíveis associações clínicas e laboratoriais. MÉTODOS: Estudo transversal de 46 pacientes (93,5% do sexo feminino) com SAFP (critérios de Sapporo). Foram avaliados os dados demográficos e clínicos, medicações, anticorpos antifosfolípides, além da medida dos níveis séricos em jejum da lipoproteína(a). RESULTADOS: Os níveis de lipoproteína(a) ( > 30 mg/dL) foram vistos em 43,5% dos pacientes com SAFP, com média de 42 ± 43,5 mg/dL. Comparando-se o grupo com níveis maiores que 30 mg/dL com o grupo de pacientes com níveis menores ou iguais a este valor, não foram observadas diferenças significativas em relação a dados demográficos (idade, sexo, cor branca, peso, altura e índice de massa corporal), manifestações da doença (eventos arteriais, venosos, obstétricos, plaquetopenia), eventos cardiovasculares (infarto agudo do miocárdio, angina, acidente vascular cerebral), comorbidades, estilo de vida (atividade física, tabagismo atual e pregresso), uso de medicações (corticoide atual e pregresso, estatina, cloroquina), bem como à frequência de positividade de anticorpos antifosfolípides. CONCLUSÃO: Pacientes com SAFP apresentam uma frequência elevada de níveis aumentados de lipoproteína(a). Entretanto, nenhuma associação dessa anormalidade com as variáveis clínicas e laboratoriais estudadas foi encontrada.OBJECTIVE: To evaluate levels of lipoprotein(a) in patients with primary antiphospholipid syndrome (PAPS) and its possible associations with clinical and laboratory features. METHODS: Transversal study with 46 (93.5% female) PAPS patients (Sapporo criteria). Demographic, clinical, drugs use, and antiphospholipid antibodies data were evaluated, as well as measurements of lipoprotein(a) serum fasting levels. RESULTS: Elevated levels of lipoprotein(a) ( > 30 mg/dL) were observed in 43.5% of PAPS patients, with a mean of 42 ± 43.5 mg/dL. A comparison between patients with lipoprotein(a) higher than 30 mg/dL and those with < 30 mg/dL did not show any differences regarding demographics (age, gender, white race, weight, height, body mass index), diseases features (arterial, venous or obstetric events, thrombocytopenia), cardiovascular manifestations (acute myocardial infarct, angina, stroke), comorbidities, life style (physical activity, smoking), drugs use (corticosteroids, statins, chloroquine), as well as the frequency of positivity of antiphospholipid antibodies. CONCLUSION: PAPS patients had a high frequency of increased levels of lipoprotein(a), however there was no association of this abnormality with the clinical and laboratorial features herein studied.

Con el objetivo de investigar la función que ejerce la lipoproteína (a) como factor de riesgo independiente en diferentes procesos cardiovasculares se determinaron los valores de la misma en 50 sujetos sin enfermedad arterial coronaria y en 92 pacientes isquémicos. Se determinaron las concentraciones de colesterol total, HDL, LDL, triglicéridos y VLDL. Aunque las concentraciones promedio de Lp(a) fueron superiores en los pacientes que en los controles, sólo se obtuvo diferencias significativas para el grupo angina (p=0,036*). Los factores de riesgo adicionales que mostraron valores patológicos fueron el colesterol total, las LDL, HDL y los triglicéridos con diferencias significativas para los 2 primeros de p < 0,05 y p < 0,01. Se concluyó que en nuestro estudio, la lipoproteína (a) constituyó un factor de riesgo independiente de enfermedad cardiovascular por lo que su determinación debe ser incluída en las prácticas clínicas.In order to investigate the function of lipoprotein (a) as an independent risk factor in different cardiovascular processes, its values were determined in 50 subjects with no coronary arterial disease and in 92 ischemic patients. The concentrations of total cholesterol, HDL, LDL, triglycerides and VLDL were determined. Though the average concentrations of Lp(a) were higher in patients than in controls, significant differences were only obtained for the angina group (p=0.0368*). The aditional risk factors showing pathological values were total cholesterol, LDL, HDL and triglycerides with marked differences for the first two of p

Aim: To study new risk factors for peripheral macroangiopathy (PM) in patients with diabetes, as oxidative stress (OS) and its interaction with classical risk factors: age, Lp(a), plasma homocysteine values and HbA1c., Subjects and Methods: We studied 204 type2 diabetic (T2DM) patients, consecutive selected form a reference hospital and a secondary hospital form our Community (2009-2010). Design was a case (ABI<0.89) control (ABI0.9-1.2) study. PM was defined using ankle brachial index (ABI). Thirty nine T2DM subjects presented ABI>1.2 and were excluded. Clinical and biological parameters were determined using standard methods., Results: Comparing clinical and biological parameters obtained in both studied groups (T2DM+ABI<0.9 vs T2DM+ABI0.9-1.2), we found statistical significant differences in age, evolution time of diabetes, Lp(a) and plasma homocysteine values. No differences were found in OS parameters: reduced glutathione, oxidized glutathione and maloldialdehide between studied groups. Plasma homocysteine values were an independent risk factor for the presence of PM and were related to evolution time of diabetes and reduced glutathione., Conclusions: We have confirmed that Lp(a) and independently plasma homocysteine values were related to PM in T2DM subjects. No association with PM and OS markers (GSH, GSSG and MDA) were found in T2DM with more than 10years of evolution time of their disease and high prevalence of chronic complications., (Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)