A new emerging risk factor for cardiovascular disease : Apo(a) polymorphism

Apolipoprotein(a) [apo(a)], the specific apolipoprotein of lipoprotein(a), is characterized by a high degree of genetic polymorphism. Recent studies have shown that apo(a) polymorphism may represent a powerful independent cardiovascular risk factor. Indeed, an association between apo(a) polymorphism and coronary artery disease (CAD) has been documented both in the general population and among subjects at high cardiovascular disease risk, such as hypertensive, uremic, hypercholesterolemic, and diabetic patients. In addition, apo(a) polymorphism seems to correlate well with age of onset and severity of CAD. Nevertheless, at present, some problems prohibit the utilization of apo(a) polymorphism in clinical practice. Indeed, apo(a) phenotyping methods are not standardized, and there is not a cutoff of apo(a) polymorphism for clinical purposes. Moreover, large prospective studies should confirm the predictive value of apo(a) polymorphism for CAD. When the above problems are solved, apo(a) polymorphism could be a reliable tool to discriminate subjects with genetic predisposition to CAD among people with a family history of CAD and among patients with diseases representing a high cardiovascular risk, such as hypercholesterolemia, hypertension, diabetes, and uremia.