Second, Lp(a)-mediated inflammatory responses exacerbate cardiovascular damage by activating the monocyte-macrophage system, which stimulates the release of inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), thereby accelerating vascular inflammation and atherosclerosis progression (50, 51). Here, TNF is linked to atherosclerosis.