Lipoprotéine(a) et risque cardiovasculaire

Abstract

AbstractDiscovered 60 years ago, lipoprotein (a) was very quickly recognized as an independent cardiovascular risk factor when its genetically determined concentration was high. Lp(a) is a lipoprotein containing apolipoprotein B100 like LDL but distinguished by the presence of an apolipoprotein (a) molecule. This apo(a) exhibits a very great structural heterogeneity as a function of the number of copies of the “kringle IV2” motif, making it possible to distinguish between small isoforms and large isoforms. The plasma concentration of Lp(a) is inversely proportional to the size of the apo(a) present in the Lp(a). The atherogenic properties of Lp(a) are linked to the LDL fraction, its thrombogenic properties are due to the anti- fibrinolytic action of apo(a) due to its partial homology with plasminogen. More recently a role in vascular calcification has also been demonstrated. During the 2000s, interest in Lp(a) declined considerably. Lp(a) is now back in the spotlight because its dosage makes it possible to improve the identification and management of subjects at high cardiovascular risk and because new therapies to reduce the synthesis of apo(a) look promising.