Lipoprotein(a) as a key target in combined therapeutic approaches for cardiovascular disease

Introduction and Objective: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in p...

Full description

Bibliographic Details
Main Authors: Joaquim A. Meireles Brandão, Lúcia R. Meireles-Brandão, Rui Coelho, Francisco Rocha-Gonçalves
Format: Article
Language:English
Published: Elsevier 2019-07-01
Series:Revista Portuguesa de Cardiologia
Online Access:http://www.sciencedirect.com/science/article/pii/S0870255119304780
Description
Summary:Introduction and Objective: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention. Methods: We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients’ lifestyle were assessed. Results: Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments. Conclusions: Lp(a) is a key overall indicator of vascular risk and should be considered a therapeutic target. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process. Resumo: Introdução e objetivo: Lp(a) é um fator de risco cardiovascular independente, mas intrinsecamente associado a outros fatores de risco similares, controláveis com terapêuticas e orientações adequadas. O nosso objetivo é estudar o impacto do uso de terapêuticas combinadas na gestão da evolução da Lp(a) em doentes com elevado risco vascular, sem ECVM em prevenção primária. Métodos: Estudo observacional retrospetivo realizado em 516 doentes, selecionados aleatoriamente de um universo de 1677 indivíduos, que participaram regularmente em consultas de risco vascular e metabolismo entre 1995 e 2015. As patologias observadas e terapêuticas utilizadas foram distribuídas em diferentes grupos nosológicos e grupos farmacológicos, respetivamente. Calculou-se o RV com base em FRS, SCORE e ASCVD e avaliou-se também a evolução do estilo de vida dos doentes. Resultados: Encontraram-se diferenças significativas (p<0,001) em quase todas as variáveis metabólicas, exceto insulina (jejum) e péptido-C. Houve uma redução significativa nos níveis de Lp(a) (p<0,001). A espessura íntima-média carotídea evoluiu favoravelmente, diminuindo de 2,90 mm para 1,40 mm; porém, não houve redução do número de casos de estenose vascular. Dos doentes com esteatose hepática (85,5%), 40,7% apresentaram hepatomegalia. Contudo, poucos doentes (14,5%) apresentaram função hepática alterada. A terapêutica antidislipidémica, especialmente as estatinas, diminuiu significativamente a Lp(a), beneficiando da sinergia com demais tratamentos. Conclusões: Lp(a) é um indicador global e fundamental de risco vascular, a considerar como alvo terapêutico. Além de um estilo de vida saudável, a prevenção primária deve incluir terapêuticas farmacológicas combinadas dirigidas aos fatores de risco cardiovasculares e, consequentemente, retardar o processo aterosclerótico. Keywords: Lipoprotein(a), Cardiovascular disease, Atherosclerosis, Drug therapy, combination, Cardiovascular risk, Peripheral arterial disease, Palavras-chave: Lipoproteína(a), Doenças cardiovasculares, Aterosclerose, Terapêutica farmacológica combinada, Risco cardiovascular, Doença arterial periférica
ISSN:0870-2551