Fenotipi di apolipoproteina(a) come indicatori di suscettibilità genetica per rischio cardiovascolare in medicina del lavoro

Several agents (e.g. chemical or physical) present in the work environment may be harmful for the cardiovascular system. Recent studies on the cardiovascular diseases linked to hyperlipidemia have demonstrated a strong correlation between high lipoprotein(a) [Lp(a)] levels and Coronary Heart Disease (CHD). In particular, the severity of this pathological condition correlates well with the molecular weight (MW) of the apolipoprotein(a) [apo(a)] isoforms supporting Lp(a) (low MW = high risk; high MW = low risk), which are characterized by a high degree of individual variability. Since apo(a) isoforms are genetically determined, a genetic predisposition for CHD has been identified, i.e. the apo(a) phenotype is considered a marker of genetic susceptibility for cardiovascular risk. After a brief presentation of the main occupational cardiovascular risk factors (e.g. carbon disulfide, carbon monoxide, noise, psycho-physical stress) and of the most updated theories on atherogenesis, the present review proposes to utilize the measurement of the plasmatic Lp(a) level to screen for occupational cardiovascular risk susceptibility. Apo(a) phenotype characterization of workers with medium-high Lp(a) levels is then suggested. Our proposal may be realized by means of simple and relatively unexpensive laboratory methods.