Saitta A, Castaldo M, Sardo A, Cinquegrani M, Bonaiuto M, Zema M, Gravina M, Mangano C
Dipartimento di Medicina Interna e Terapia Medica, Università degli Studi, Messina.
Minerva Med. 1999 May-Jun;90(5-6):151-8.
Elevated levels of lipoprotein(a) are associated with a greater risk of atherothrombotic cardiovascular diseases. Since the Lp(a) levels are genetically determined and fairly stable in the course of life and a family history appears to be an independent risk factor of cardiovascular diseases, we evaluated the behavior of Lp(a) levels in patients with early events of coronary heart disease (CHD) and also in subjects with positive family history of ischemic heart diseases.
The levels of lipoprotein (a) [Lp(a)] were measured in 254 subjects, 138 males and 116 females with an average age of 48.6 +/- 13.8 years (range 20-76 years). Diabetic subjects, females submitted to oestrogen treatment and those already in treatment with hypolipidaemic drugs were excluded from the study. Forty of the 254 patients (15.7%), 27 males and 13 females, had CHD (29 a previous myocardial infarction and 11 a stable angina). A positive family history for CHD was considered present (102 of the 254 patients) if one or more first degree relatives had angina or myocardial infarction before the age of 60 years in men and 65 in women.
The levels of Lp(a) were higher (p < 0.01) in women (25.1 +/- 28.3 mg/dl) compared to men (17.6 +/- 18.4 mg/dl), without differences in relation to age. The Lp(a) plasmatic levels were not correlated with age, body mass index, total cholesterol, LDL and HDL, triglycerides, apo B, apo AI, fibrinogen and there were no differences in Lp(a) levels in presence or absence of other known cardiovascular risk factors such as hypertension and smoking. The Lp(a) levels were not different between subjects with CHD (28.15 +/- 31.7 mg/dl) and controls (20.3 +/- 22.8 mg/dl). The subjects with CHD were older and had higher levels of fibrinogen and a significantly greater prevalence of hypertension and family history of CHD. Fifteen of the 40 subjects with CHD had an early onset of CHD (before 50 years of age) and only in such patients the Lp(a) levels were significantly greater compared to controls (35.8 +/- 33.2 mg/dl vs 20.3 +/- 22.8 of the controls, p < 0.01), independently of other variables (age, BMI, smoking, hypertension, cholesterol, triglycerides, HDL-c, LDL-c, fibrinogen). Furthermore the Lp(a) plasmatic levels were higher in subjects with a family history of CHD (28.3 +/- 27.6 mg/dl vs 16.3 +/- 18.6 mg/dl of the subjects without a family history of CHD, p < 0.01) even if they had or not had a previous coronary ischemic event.
Such data confirm the importance of high levels of Lp(a) above all for the early events of CHD and for the subjects with a family history of CHD, which could be expression of a greater predisposition for cardiovascular events.
脂蛋白(a)水平升高与动脉粥样硬化性心血管疾病风险增加相关。由于脂蛋白(a)水平由基因决定且在生命过程中相当稳定，家族史似乎是心血管疾病的独立危险因素，我们评估了冠心病（CHD）早期发病患者以及有缺血性心脏病家族史受试者的脂蛋白(a)水平变化情况。
对254名受试者（138名男性和116名女性）进行脂蛋白(a)[Lp(a)]水平检测，平均年龄为48.6±13.8岁（范围20 - 76岁）。糖尿病患者、接受雌激素治疗的女性以及已接受降血脂药物治疗的患者被排除在研究之外。254名患者中有40名（15.7%）患有CHD，其中27名男性和13名女性，29名曾发生心肌梗死，11名患有稳定型心绞痛。如果一名或多名一级亲属在男性60岁之前、女性65岁之前患有心绞痛或心肌梗死，则认为该患者有CHD阳性家族史（254名患者中有102名）。
女性（25.1±28.3mg/dl）的Lp(a)水平高于男性（17.6±18.4mg/dl）（p < 0.01），与年龄无关。Lp(a)血浆水平与年龄、体重指数、总胆固醇、低密度脂蛋白和高密度脂蛋白、甘油三酯、载脂蛋白B、载脂蛋白AI、纤维蛋白原均无相关性，在有无高血压和吸烟等其他已知心血管危险因素的情况下，Lp(a)水平也无差异。CHD患者（28.15±31.7mg/dl）和对照组（20.3±22.8mg/dl）的Lp(a)水平无差异。CHD患者年龄更大，纤维蛋白原水平更高，高血压和CHD家族史的患病率显著更高。40名CHD患者中有15名CHD发病较早（50岁之前），仅在这些患者中，Lp(a)水平显著高于对照组（35.8±33.2mg/dl对对照组的20.3±22.8mg/dl，p < 0.01），独立于其他变量（年龄、体重指数、吸烟、高血压、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、纤维蛋白原）。此外，有CHD家族史的受试者Lp(a)血浆水平更高（28.3±27.6mg/dl对无CHD家族史受试者的16.3±18.6mg/dl，p < 0.01），无论他们之前是否有过冠状动脉缺血事件。
这些数据证实了高水平Lp(a)的重要性，尤其是对于CHD早期发病患者以及有CHD家族史的受试者，这可能是心血管事件易感性更高的表现。
