Primary and secondary prevention of cardiovascular disease in patients with hyperlipoproteinemia (a)

Abstract

General lipoprotein (Lp) (a) screening can help to identify patients at high risk for cardiovascular disease. Non-invasive methods allow early detection of clinically asymptomatic incipient atherosclerotic disease. Medical treatment options are still unsatisfactory. Lp(a) apheresis is an established treatment in Germany for secondary prevention of progressive cardiovascular disease. Statin-based lowering of LDL cholesterol and thrombocyte aggregation inhibitors still represent the basis of medical treatment. Target levels for LDL-cholesterol should be modified in patients with hyperlipoproteinemia (a).

Reduced Cardiovascular Disease Deaths in 21 Western Countries 1989-91 V 2013-154: What is the UK doing Right or What is the USA doing Wrong?

“…Is this an indication of the effects of reduction of smoking [12]? Though the issue of increased obesity is a problem for future outcomes as obesity and CDD are linked [7,21,22]. It is feared that we may well see a reverse of these good CDD results in the coming years because of rises in obesity and type 2 diabetes in many Western countries [23,26].…”

“…It is appreciated that there may be many different clinical and social reasons for the reduction in CDD; for example -improved diagnostic monitoring and surgical procedures [3,4]; the use of lipid lowering therapy such as statins [5,6]; improved lifestyles [7,8]; reducing over-work [9,10]; cessation of smoking in public venues [11,12] invasive percutaneous intervention in patients presenting with acute coronary syndromes, as well as effective treatment of hypertension [13], diabetes and atherosclerosis [13,14]. There is a degree of debate whether public health approach, such as dietary changes, as opposed to treatment initiatives, have made the greater contribution [7,11,14].…”

How should public health recommendations address Lp(a) measurement, a causative risk factor for cardiovascular disease (CVD)?

“…For example, patients with high Lp(a) concentrations may have less-than expected LDL-C lowering on statin therapy and have greater residual CVD risk despite maximum tolerated treatment with statin and ezetimibe [19]. However, they would derive greater relative benefit from PCSK9 inhibitor therapy, as this may additionally reduce Lp(a) by 15-30%, but the reduction rate is below 20% in patients with high Lp(a) concentrations [20][21][22]. This could contribute to the reduction of premature CVD events and associated deaths and generate healthcare system savings.…”

Biofluid lipidome: a source for potential diagnostic biomarkers

“…The above discussed diverse functions of lipids and more make it only rational and important to study the changes in the lipidome of a cell, organ or tissue to understand a disease phenomenon. A significant number of ailments have been associated with altered lipid metabolism [26–31]. Fatty acid synthase and insulin response in obesity has been reported to be controlled by lipid metabolites [32–34].…”