Lipoprotein(a), Interleukin-6 inhibitors, and atherosclerotic cardiovascular disease: Is there an association?
Author(s)
Makris, Anastasios
Barkas, Fotios
Sfikakis, Petros P
Liberopoulos, Evangelos
Filippatos, Theodosios D
Type
Journal Article
Abstract
BACKGROUND AND AIMS: Lipoprotein(a) [Lp(a)] and interleuking-6 (IL-6), an inflammation biomarker, have been established as distinct targets of the residual atherosclerotic cardiovascular disease (ASCVD) risk. We aimed to investigate the association between them, and the potential clinical implications in ASCVD prevention. METHODS: A literature search was conducted in PubMed until December 31st, 2022, using relevant keywords. RESULTS: Elevated lipoprotein(a) [Lp(a)] levels constitute the most common inherited lipid disorder associated with ASCVD. Although Lp(a) levels are mostly determined genetically by the LPA gene locus, they may be altered by acute conditions of stress and chronic inflammatory diseases. Considering its resemblance with low-density lipoproteins, Lp(a) is involved in atherosclerosis, but it also exerts oxidative, thrombotic, antifibrinolytic and inflammatory properties. The cardiovascular efficacy of therapies lowering Lp(a) by >90% is currently investigated. On the other hand, interleukin (IL)-1b/IL-6 pathway also plays a pivotal role in atherosclerosis and residual ASCVD risk. IL-6 receptor inhibitors [IL-6(R)i] lower Lp(a) by 16-41%, whereas ongoing trials are investigating their potential anti-atherosclerotic effect. The Lp(a)-lowering effect of IL-6(R)i might be attributed to the inhibition of the IL-6 response elements in the promoter region of the LPA gene. CONCLUSIONS: Although the effect of IL-6(R)i on Lp(a) levels is inferior to that of available Lp(a)-lowering therapies, the dual effect of the former on both inflammation and apolipoprotein (a) synthesis may prove of equal or even greater significance when it comes ASCVD outcomes. More trials are required to establish IL-6(R)i in ASCVD prevention and elucidate their interplay with Lp(a) as well as its clinical significance.
Date Issued
2023-12
Date Acceptance
2023-09-06
Citation
Atherosclerosis Plus, 2023, 54, pp.1-6
ISSN
2667-0895
Publisher
Elsevier
Start Page
1
End Page
6
Journal / Book Title
Atherosclerosis Plus
Volume
54
Copyright Statement
© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37720252
PII: S2667-0895(23)00037-8
Subjects
Atherosclerotic cardiovascular disease
IL-6
IL-6 inhibitor
Interleukin 6
Lipoprotein(a)
Lp(a)
Publication Status
Published
Coverage Spatial
Netherlands
Date Publish Online
2023-09-09