Vloga lipoproteina (a) v patogenezi ishemične bolezni srca, degenerativne aortne stenoze in srčnega popuščanja
DOI:
https://doi.org/10.6016/ZdravVestn.3057Ključne besede:
lipoprotein (a), ishemična bolezen srca, degenerativna aortna stenoza in srčno popuščanjePovzetek
Lipoprotein a [lipoprotein mali a, Lp (a)] je poznan in dobro raziskan dejavnik tveganja za aterosklerotične srčno-žilne bolezni. Lp (a) se s svojimi protrombogenimi in proaterogenimi lastnostmi pomembno vpleta v patogenezo ateroskleroze. Povišane koncentracije Lp (a) so se – neodvisno od ostalih dejavnikov tveganja – izkazale kot neodvisni napovedni dejavnik za miokardni infarkt oz. ishemično bolezen srca ter možgansko kap. Degenerativna aortna stenoza je najpogostejša bolezen zaklopk, povezana s podobnimi dejavniki tveganja kot ishemična bolezen srca. Povišane vrednosti Lp (a) igrajo pomembno vlogo tudi pri nastanku in napredovanju degenerativne aortne stenoze, saj Lp (a) sodeluje v procesu kalcificiranja zaklopke, ki je eden pomembnejših dejavnikov za razvoj bolezni. Patofiziološka vloga Lp (a) v nastanku degenerativne aortne stenoze pa se zrcali tudi v opazovalnih in genetskih raziskavah, v katerih so ugotovili, da so povišane vrednosti Lp (a) povezane z višjim tveganjem za stenozo aortne zaklopke. Nekoliko manj pa je jasna vloga hiperlipoproteinemije a pri razvoju srčnega popuščanja. Med polimorfizmi Lp (a) sta dva povezana z razvojem srčnega popuščanja (rs3798220 in rs10455872). Povečini je srčno popuščanje pri populaciji s povišanimi vrednostmi Lp (a) posledica miokardnega infarkta oz. ishemične bolezni srca ter degenerativne aortne stenoze. Kljub temu pa je polimorfizem rs3798220 povezan z višjo pojavnostjo srčnega popuščanja, ki ni posledica ishemične bolezni srca ali aortne stenoze. V preglednem članku predstavljamo patofiziološki in klinični pomen hiperlipoproteinemije a pri ishemični bolezni srca, degenerativni aortni stenozi ter srčnem popuščanju, vključno z razpravljanjem.
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