Role of lipoprotein (A) in pathogenesis of ischemic heart disease, degenerative aortic stenosis, and heart failure

Abstract

Lipoprotein (a) [Lp (a)] is a well-established risk factor for atherosclerotic cardiovascular disease. Lp(a) shows unique proatherogenic and thrombogenic properties that are important in athero-thrombosis, and its elevated concentrations have shown a causal relationship with an increased risk of myocardial infarction/ ischaemic heart diseases and stroke, independent of classical risk factors. Degenerative valvular aortic stenosis is the most prevalent valvular heart disease, and it shares common risk factors with ischaemic heart disease. Lp(a) has been shown to promote valve calcification and disease progression. A mechanistic link between Lp(a) and aortic stenosis was further confirmed in observational and genetic studies of patients with increased Lp(a) concentrations. On the other hand, the role of Lp(a) in the development of heart failure is less clear. Two polymorphisms of Lp(a), rs3798220 and rs10455872, have emerged as predictors of the development of heart failure. Lp(a)-related risk for heart failure is mostly associated with ischaemic heart disease and valvular aortic stenosis. However, the association of the rs3798220 polymorphism with heart failure can not be explained by either ischemic heart disease or valvular aortic stenosis. The present review aims to summarize and discuss the current state of the literature on pathophysiological and clinical aspects of Lp(a), with a focus on ischaemic heart disease, degenerative aortic valve stenosis, and heart failure.