Efek Statin pada Kadar Lipoprotein(a)

Oleh :

dr. Hendra Gunawan SpPD

Suatu studi yang dipublikasikan pada awal tahun 2019 melaporkan bahwa statin dapat meningkatkan kadar lipoprotein(a). Hal ini sempat menimbulkan kekhawatiran karena lipoprotein(a) diketahui merupakan faktor risiko penyakit kardiovaskular. Studi-studi pun akhirnya mulai banyak dilakukan untuk mempelajari apakah peningkatan konsentrasi lipoprotein(a) tersebut berbahaya secara klinis.

World Health Organization (WHO) melaporkan bahwa sekitar 17,9 juta orang meninggal karena penyakit kardiovaskular tiap tahun. Penyakit kardiovaskular memiliki berbagai faktor risiko, salah satunya adalah dislipidemia.[1,2]

Statin merupakan penghambat enzim HMG-CoA reduktase yang merupakan enzim yang berperan dalam biosintesis kolesterol. Hal ini menyebabkan penurunan kolesterol intraseluler lalu meningkatkan ekspresi reseptor LDL (low-density lipoprotein) pada permukaan sel hepar. Akibatnya, terjadi penurunan LDL dan berbagai apolipoprotein yang mengandung apolipoprotein B, termasuk partikel kaya trigliserida (TG).[3,4]

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1.World Health Organization. Cardiovascular Disease Geneva: World Health Organization; 2022 [cited 2022 3 Oktober]. Available from: https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1.
2.Canto JG, Kiefe CI, Rogers WJ, Peterson ED, Frederick PD, French WJ, et al. Number of coronary heart disease risk factors and mortality in patients with first myocardial infarction. Jama. 2011;306(19):2120-7.
3.Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2019;41(1):111-88.
4.Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2021;42(34):3227-337.
5.Jang AY, Han SH, Sohn IS, Oh PC, Koh KK. Lipoprotein(a) and Cardiovascular Diseases　― Revisited ―. Circulation Journal. 2020;84(6):867-74.
6.Schmidt K, Noureen A, Kronenberg F, Utermann G. Structure, function, and genetics of lipoprotein (a). J Lipid Res. 2016;57(8):1339-59.
7.Hoogeveen RC, Ballantyne CM. Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation. Clin Chem. 2021;67(1):143-53.
8.Kamstrup PR, Hung MY, Witztum JL, Tsimikas S, Nordestgaard BG. Oxidized Phospholipids and Risk of Calcific Aortic Valve Disease: The Copenhagen General Population Study. Arterioscler Thromb Vasc Biol. 2017;37(8):1570-8.
9.Cain WJ, Millar JS, Himebauch AS, Tietge UJ, Maugeais C, Usher D, et al. Lipoprotein [a] is cleared from the plasma primarily by the liver in a process mediated by apolipoprotein [a]. J Lipid Res. 2005;46(12):2681-91.
10.Tsimikas S, Gordts PLSM, Nora C, Yeang C, Witztum JL. Statin therapy increases lipoprotein(a) levels. European Heart Journal. 2019;41(24):2275-84.
11.de Boer LM, Oorthuys AOJ, Wiegman A, Langendam MW, Kroon J, Spijker R, et al. Statin therapy and lipoprotein(a) levels: a systematic review and meta-analysis. European Journal of Preventive Cardiology. 2021;29(5):779-92.
12.O'Donoghue ML, Fazio S, Giugliano RP, Stroes ESG, Kanevsky E, Gouni-Berthold I, et al. Lipoprotein(a), PCSK9 Inhibition, and Cardiovascular Risk. Circulation. 2019;139(12):1483-92.