Universidad Fraternidad de Agrupaciones Santo Tomás de Aquino

Lipoprotein(a) [Lp(a)] is a significant player in cardiovascular disease (CVD) and type 2 diabetes (T2D). While Lp(a) contributes to residual cardiovascular risk in T2D, lower levels paradoxically increase the risk of developing T2D. This review explores Lp(a)'s dual role in cardiometabolic disease, its association with T2D, and emerging Lp(a)-lowering therapies. Large-scale studies confirm Lp(a) as a potent risk factor for cardiovascular events in T2D, with lower Lp(a) thresholds increasing risk compared to nondiabetic individuals. Observational and genetic studies reveal an inverse relationship between Lp(a) and T2D risk, linked to insulin dynamics, Kringle IV-type-2 repeat variants, and metabolic pathways. Emerging evidence suggests a connection between Lp(a), nonalcoholic fatty liver disease, and statin use. However, Mendelian randomization analyses have yielded conflicting results, leaving key mechanistic questions unresolved. Lp(a) plays a complex role in cardiometabolic health, acting as both a cardiovascular hazard and a potential metabolic marker in T2D. The paradoxical association of low Lp(a) with increased T2D risk challenges conventional perspectives and raises concerns regarding Lp(a)-lowering interventions. Further research is needed to clarify causality, refine risk stratification, and guide clinical decisions for Lp(a) modulation in T2D patients.

INTRODUCCIN Y OBJETIVOSUno de cada 8 adultos en Argentina tiene diabetes tipo 2 (DM2) 1 .La diabetes incrementa 2 a 4 veces el riesgo de presentar eventos cardiovasculares (CV) 2 .Se estima que 3 de cada 10 personas que egresan de unidades coronarias tienen diabetes 3 .Existe una necesidad insatisfecha por parte de la comunidad mdica, de documentos y algoritmos simples en la articulacin entre las normativas de pacientes hospitalizados y pacientes ambulatorios.El proceso de alta tras un evento cardaco agudo es una ventana de oportunidad para la optimizacin de tratamientos, con foco en la reduccin del riesgo de eventos recurrentes o complicaciones como: reinfarto, accidente cerebrovascular (ACV), evento isqumico de miembros inferiores, hospitalizacin por insuficiencia cardiaca (IC) o la muerte de causa cardiovascular.Por este motivo, se ha conformado un grupo de expertos para revisar los criterios de control y tratamiento actualizados en personas con DM2 y ECV establecida, abarcando metas generales de control metablico, hipertensin y dislipidemias.

The role of lipoprotein(a) [Lp(a)] as a possible causal risk factor for atherosclerotic artery disease and aortic valve stenosis has been well established. However, the information on the association between Lp(a) levels and heart failure (HF) is limited and controversial. The main objective of the present study was to assess the association between Lp(a) levels and HF. This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between Lp(a) levels and HF. Eight studies, including 73,410 patients, were eligible for this research. Seven prospective or retrospective cohorts and one cross-sectional study were analyzed. Five studies analyzed populations without HF; another three included patients with HF or left ventricular dysfunction. The endpoints evaluated varied according to the study analyzed, including incident HF, HF hospitalizations, and decreased left ventricular ejection fraction. Lp(a) levels were also analyzed in different ways, including analysis of Lp(a) as a continuous or categorical variable (distinct cut-off points or percentiles). Globally, the studies included in this review found predominantly positive results. Data on some relevant subgroups, such as HF of ischemic or non-ischemic etiology or HF with or without left ventricular dysfunction, was poorly reported. This systematic review suggests that there would be a positive relationship between Lp(a) levels and HF. Given the complexity and heterogeneity of HF, new studies should be developed to clarify this topic.