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2020 ; 22
(9
): 48
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Lipoprotein(a) and Its Potential Association with Thrombosis and Inflammation in
COVID-19: a Testable Hypothesis
#MMPMID32710255
Moriarty PM
; Gorby LK
; Stroes ES
; Kastelein JP
; Davidson M
; Tsimikas S
Curr Atheroscler Rep
2020[Jul]; 22
(9
): 48
PMID32710255
show ga
PURPOSE OF REVIEW: The COVID-19 pandemic has infected over > 11 million as of
today people worldwide and is associated with significant cardiovascular
manifestations, particularly in subjects with preexisting comorbidities and
cardiovascular risk factors. Recently, a predisposition for arterial and venous
thromboses has been reported in COVID-19 infection. We hypothesize that besides
conventional risk factors, subjects with elevated lipoprotein(a) (Lp(a)) may have
a particularly high risk of developing cardiovascular complications. RECENT
FINDINGS: The Lp(a) molecule has the propensity for inhibiting endogenous
fibrinolysis through its apolipoprotein(a) component and for enhancing
proinflammatory effects such as through its content of oxidized phospholipids.
The LPA gene contains an interleukin-6 (IL-6) response element that may induce an
acute phase-type increase in Lp(a) levels following a cytokine storm from
COVID-19. Thus, subjects with either baseline elevated Lp(a) or those who have an
increase following COVID-19 infection, or both, may be at very high risk of
developing thromboses. Elevated Lp(a) may also lead to acute destabilization of
preexisting but quiescent atherosclerotic plaques, which might induce acute
myocardial infarction and stroke. Ongoing studies with IL-6 antagonists may be
informative in understanding this relationship, and registries are being
initiated to measure Lp(a) in subjects infected with COVID-19. If indeed an
association is suggestive of being causal, consideration can be given to
systematic testing of Lp(a) and prophylactic systemic anticoagulation in infected
inpatients. Therapeutic lipid apheresis and pharmacotherapy for the reduction of
Lp(a) levels may minimize thrombogenic potential and proinflammatory effects. We
propose studies to test the hypothesis that Lp(a) may contribute to
cardiovascular complications of COVID-19.