脂蛋白(a)的意义和它如何影响我的心脏健康?

阅读这篇西班牙语文章: ¿quuques la Lp(a) y cómo afecta mi salud cardíaca? (PDF)

Committed to avoiding the heart disease that ran in her family, Sandra Revill Tremulis adopted a healthy lifestyle and prioritized annual preventive screenings. Despite maintaining normal cholesterol numbers, plaque built up on the walls of her arteries. At age 39, she almost died of a 心脏病 caused by a 95% blockage.

Further testing showed the likely problem; Tremulis had high numbers of lipoprotein(a), or Lp(a).

“That was the beginning of my education and my empowerment,”她说。. “我简直不敢相信人们没有谈论这件事.”

在接下来的几年里, 她研究了Lp(a), 跟医疗专业人员谈过了, 并成立了一个基金会来提高人们对这种疾病的认识. These efforts led to the Centers for Disease Control and Prevention (CDC) recognizing high Lp(a) numbers as a clinical diagnosis in 2018. They approved diagnosis codes for billing and payment related to clinical work and laboratory testing.

“I wanted to make sure that there's help for every child who inherits this so that they can change their cardiovascular destiny,”她说。.

Lp (a)是什么?

Lp(a) is a genetically inherited lipoprotein and a common independent risk factor for heart disease. Lp(a) is made up of two major proteins: apolipoprotein(a) [apo(a)] and apolipoprotein B (apoB)-100. 尽管Lp(a)和 低密度脂蛋白 (LDL), 或者“坏”胆固醇, 两者都含有载脂蛋白b颗粒, 它们是具有独特特性的不同脂蛋白. Similar to Lp(a), high apoB numbers are associated with an increased risk of heart disease. Ask your doctor if ordering a lab test to measure your apoB numbers is right for you.

为什么Lp(a)会增加我患心脏病的风险?

High Lp(a) numbers of 50 mg/dL (125 nmols/L) or higher promote clotting and inflammation, 显著增加 心脏病, stroke, 主动脉瓣狭窄 and 外周动脉疾病. This is especially true for those with coronary heart disease or 家族性高胆固醇血症, or FH, an inherited condition that affects the body’s ability to process LDL “bad” cholesterol.

Lp(a) can accumulate in the walls of blood vessels, forming plaques similarly to LDL cholesterol. These plaques can block blood flow to vital organs such as the heart, brain, 肾脏, lungs, 以及身体的其他部位, 导致心脏病等疾病, strokes, 以及其他心血管疾病.

Recent preliminary studies have determined a possible connection between high Lp(a) numbers and the risk of calcific aortic valve disease (CAVD). High Lp(a) numbers increase inflammation and calcification in heart cells, 导致主动脉瓣内的钙积聚.

我如何知道自己是否有患高脂蛋白(a)的风险??

许多高Lp(a)患者没有症状, so it’s important to talk with your health care professional if you have any of the following:

• Family history of high Lp(a) or early development of heart disease.
• 家族性高胆固醇血症(FH), about a third of people with the condition also have high Lp(a) numbers.
• 个人心脏病发作史, stroke, or coronary artery disease before age 55 in men or age 65 in women.
• Poor circulation in your legs because of peripheral arterial disease.
• 主动脉狭窄的诊断, a narrowing of the valve between the heart’s lower left chamber and the aorta artery.

Does my ethnicity or any other factors put me at a higher risk for high Lp(a)?

而高Lp(a)值出现在所有种族的人群中, South Asian and Black people of African descent have the highest numbers. People with FH and kidney disease are also more likely to have high Lp(a) numbers. Women aged 50 and older have also been shown to have higher Lp(a) numbers than men.

如何检测我的Lp(a)?

和你的健康护理专家谈谈, especially if you have a family or personal history of heart disease. 而Lp(a)不包括在大多数胆固醇测试中, 你的医生可以要求你做一个单独的血液测试来测量Lp(a)。.

如何降低我的Lp(a)?

而生活方式的改变不会影响你的Lp(a)值, 医生建议高脂蛋白(a)的人保持活跃, 健康饮食, 保证充足的睡眠, 避免吸烟, 保持健康的身体质量指数, or BMI.

“生活的真谛 are the key measures for improving and maintaining cardiovascular health (as defined by the 美国心脏协会),雷耶斯-索弗说.

控制你的胆固醇也很重要, 说Reyes-Soffer, noting that having high numbers of LDL and Lp(a) may further increase your risk of heart disease.

Lipoprotein apheresis is a recommended treatment option for eligible 家族性高胆固醇血症 patients with high numbers of both LDL and Lp(a). This procedure involves filtering out both Lp(a) and LDL, temporarily lowering their numbers. Ask your health care professional about appropriate treatment options for you.

展望未来

“New treatments to lower Lp(a) levels are in the works and could hit the market as soon as 2025”, Reyes-Soffer说.

Reyes-Soffer说 she supports the Centers for Disease Control and Prevention’s efforts to develop national standards around the levels of Lp(a) that increase risk and whether that varies from person to person, 种族或其他因素.

“Having the standardization of the assays so that we can ascertain the levels that place individuals at risk and who will benefit from new drugs is very important,”她说。. 知识就是力量.”