Letter to the Editor
Lipoprotein(a) in familial hypercholesterolemia: Tips from family history
Lipoproteína (a) na hipercolesterolemia familiar: «truques» de histórias familiares
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class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Francesco" "apellidos" => "Sbrana" "email" => array:1 [ 0 => "francesco.sbrana@ftgm.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Michele" "apellidos" => "Coceani" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Federico" "apellidos" => "Bigazzi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Tiziana" "apellidos" => "Sampietro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Lipoapheresis Unit and Reference Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Invasive Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Pisa, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Lipoproteína (a) na hipercolesterolemia familiar: «truques» de histórias familiares" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1846 "Ancho" => 2508 "Tamanyo" => 213559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pedigree of the proband family 1.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The proband (subject III.4) was referred to our Institute after percutaneous coronary intervention and was diagnosed with <span class="elsevierStyleItalic">FH LDL-receptor</span> gene (c.1860G>A) mutation. The other family members were identified by cascade screening and consequently treated. Two cousins with extremely high levels of Lp(a) associated with FH were started on lipoprotein apheresis (subject III.5 had undergone percutaneous coronary intervention, whereas subject III.6 had had a rapid progression of carotid atherosclerosis despite statin therapy). The proband (subject III.4) was treated temporarily with lipoprotein apheresis, which was subsequently replaced with PCSK9i therapy.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Legend</span>: *: Proband; ▴: concomitant spinocerebellar ataxias with hyper-CPK; ATS: peripheral atherosclerosis on carotid vessels; CAD: coronary artery disease; HDL-C: high density lipoprotein cholesterol (mg/dl); LDL-C: low density lipoprotein cholesterol (mg/dl); Lp(a): lipoprotein(a) (mg/dl); TC: total cholesterol (mg/dl); TG: triglycerides (mg/dl); <span class="elsevierStyleItalic">y</span>: years.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the paper by Brandão et al. entitled <span class="elsevierStyleItalic">“</span>Lipoprotein(a) as a key target in combined therapeutic approaches for cardiovascular disease<span class="elsevierStyleItalic">”</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> highlighting, in the era of new lipid-lowering drugs,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3</span></a> the value of Lipoprotein(a) [Lp(a)] as a risk factor for atherosclerotic cardiovascular disease<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> and the importance of its measurement in the cascade screening of familial hypercholesterolemia (FH).<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> We were comforted by these results because we have been dosing Lp(a) at our Institute for this specific purpose for many years now. Indeed, already in the 1980s, the central role of Lp(a) in cardiovascular disease was demonstrated by various lines of research – epidemiology, biochemistry, pathophysiology<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> and, unsurprisingly, measurement of Lp(a) has been strongly advocated in FH, as well as in other more frequent forms of dyslipidemia.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Subsequent studies reinforced the importance of Lp(a), which should be assessed in all patients with premature coronary artery disease (CAD) in the absence of major coronary risk factors. Moreover, Lp(a) levels have been found to have a causal role in CAD and the relationship is so strong that, in some countries (such as Germany), Lp(a)-lowering therapy (i.e. lipoprotein apheresis) is reimbursed by the public health system.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The paper by Ellis et al. has the merits of unifying the vision of Lp(a) across the Atlantic and draws attention to an argument which, still today, represents a missed opportunity in cardiovascular medicine, especially considering that we finally have the therapeutic means to intervene in patients with elevated Lp(a). In addition, the study provides the impetus to associate cascade screening with personalized therapy, as exemplified by the case of a family cared for at our Institute (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). In these cases, we were able to obtain an optimal balance between maximally tolerated lipid-lowering therapy, proprotein convertase subtilisin kexin type 9 inhibitors (PCSK9i) and lipoprotein apheresis. It should be borne in mind that PCSK9i therapy can be titrated to maintain adequate LDL-C levels while increasing the administration interval,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> although the effect on Lp(a) levels may be unpredictable.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding sources</span><p id="par0020" class="elsevierStylePara elsevierViewall">No financial support was received.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding sources" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack520704" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1846 "Ancho" => 2508 "Tamanyo" => 213559 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pedigree of the proband family 1.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The proband (subject III.4) was referred to our Institute after percutaneous coronary intervention and was diagnosed with <span class="elsevierStyleItalic">FH LDL-receptor</span> gene (c.1860G>A) mutation. The other family members were identified by cascade screening and consequently treated. Two cousins with extremely high levels of Lp(a) associated with FH were started on lipoprotein apheresis (subject III.5 had undergone percutaneous coronary intervention, whereas subject III.6 had had a rapid progression of carotid atherosclerosis despite statin therapy). The proband (subject III.4) was treated temporarily with lipoprotein apheresis, which was subsequently replaced with PCSK9i therapy.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Legend</span>: *: Proband; ▴: concomitant spinocerebellar ataxias with hyper-CPK; ATS: peripheral atherosclerosis on carotid vessels; CAD: coronary artery disease; HDL-C: high density lipoprotein cholesterol (mg/dl); LDL-C: low density lipoprotein cholesterol (mg/dl); Lp(a): lipoprotein(a) (mg/dl); TC: total cholesterol (mg/dl); TG: triglycerides (mg/dl); <span class="elsevierStyleItalic">y</span>: years.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lipoprotein(a) as a key target in combined therapeutic approaches for cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A.M. Brandão" 1 => "L.R. Meireles-Brandão" 2 => "R. Coelho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2019.01.006" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2019" "volumen" => "38" "paginaInicial" => "485" "paginaFinal" => "493" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31530423" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and cardiovascular disease event rates among African Americans and Whites who meet the further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk (Fourier) trial inclusion criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.D. Colantonio" 1 => "K.L. Monda" 2 => "R.S. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 7 | 13 |
| 2024 Outubro | 47 | 42 | 89 |
| 2024 Setembro | 54 | 26 | 80 |
| 2024 Agosto | 48 | 28 | 76 |
| 2024 Julho | 42 | 38 | 80 |
| 2024 Junho | 39 | 25 | 64 |
| 2024 Maio | 43 | 16 | 59 |
| 2024 Abril | 42 | 30 | 72 |
| 2024 Maro | 42 | 21 | 63 |
| 2024 Fevereiro | 41 | 21 | 62 |
| 2024 Janeiro | 33 | 25 | 58 |
| 2023 Dezembro | 27 | 19 | 46 |
| 2023 Novembro | 43 | 33 | 76 |
| 2023 Outubro | 34 | 13 | 47 |
| 2023 Setembro | 29 | 25 | 54 |
| 2023 Agosto | 23 | 18 | 41 |
| 2023 Julho | 40 | 12 | 52 |
| 2023 Junho | 44 | 15 | 59 |
| 2023 Maio | 38 | 29 | 67 |
| 2023 Abril | 38 | 3 | 41 |
| 2023 Maro | 47 | 38 | 85 |
| 2023 Fevereiro | 38 | 16 | 54 |
| 2023 Janeiro | 24 | 17 | 41 |
| 2022 Dezembro | 49 | 22 | 71 |
| 2022 Novembro | 38 | 33 | 71 |
| 2022 Outubro | 54 | 28 | 82 |
| 2022 Setembro | 37 | 41 | 78 |
| 2022 Agosto | 43 | 36 | 79 |
| 2022 Julho | 45 | 48 | 93 |
| 2022 Junho | 50 | 36 | 86 |
| 2022 Maio | 38 | 40 | 78 |
| 2022 Abril | 51 | 37 | 88 |
| 2022 Maro | 51 | 59 | 110 |
| 2022 Fevereiro | 35 | 37 | 72 |
| 2022 Janeiro | 27 | 19 | 46 |
| 2021 Dezembro | 32 | 37 | 69 |
| 2021 Novembro | 28 | 37 | 65 |
| 2021 Outubro | 37 | 53 | 90 |
| 2021 Setembro | 23 | 39 | 62 |
| 2021 Agosto | 33 | 30 | 63 |
| 2021 Julho | 14 | 23 | 37 |
| 2021 Junho | 26 | 37 | 63 |
| 2021 Maio | 42 | 50 | 92 |
| 2021 Abril | 322 | 113 | 435 |
| 2021 Maro | 121 | 72 | 193 |
| 2021 Fevereiro | 20 | 14 | 34 |
| 2021 Janeiro | 5 | 2 | 7 |
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