Cassidy Andrea E, Bielak Lawrence F, Kullo Iftikhar J, Klee George G, Turner Stephen T, Sheedy Patrick F, Peyser Patricia A
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 47104-3028, USA.
Med Sci Monit. 2004 Sep;10(9):CR493-503. Epub 2004 Aug 20.
Lipoprotein(a) (Lp(a)) is a potential risk factor for coronary artery disease (CAD). The relationship between serum Lp(a) and coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, has not been extensively explored.
MATERIAL/METHODS: Electron beam computed tomography was performed on 616 asymptomatic, white individuals (285 men) from a community-based study. Mean age was 57.2 years. Serum Lp(a) levels were measured by an immunoturbidimetric assay. Tobit regression was used to determine the sex-specific association of Lp(a) levels with presence and quantity of CAC.
In women, Lp(a) was a significant predictor (P=0.0426) of presence and quantity of CAC after adjustment for age, hypertension status, waist circumference, presence of high low-density lipoprotein cholesterol (LDL-C), and history of smoking. In men, after adjusting for age, hypertension status, body mass index, presence of high LDL-C, and history of smoking, a positive interaction between Lp(a) and history of smoking (P=0.0387) was significantly associated with presence and quantity of CAC.
Sex-specific relationships between Lp(a) and CAC provide evidence supporting sex-specific risk factor profiling for CAD. In women, Lp(a) alone may be an independent risk factor for coronary atherosclerosis, while in men, Lp(a) may confer higher risk conditional on the presence and level of other risk factors. The role of Lp(a) in the prediction and pathogenesis of subclinical coronary atherosclerosis needs to be further elucidated.
脂蛋白(a)[Lp(a)]是冠状动脉疾病（CAD）的一个潜在危险因素。血清Lp(a)与冠状动脉钙化（CAC，一种亚临床冠状动脉粥样硬化的指标）之间的关系尚未得到广泛研究。
材料/方法：对一项基于社区的研究中616名无症状的白人个体（285名男性）进行电子束计算机断层扫描。平均年龄为57.2岁。采用免疫比浊法测定血清Lp(a)水平。使用托比特回归来确定Lp(a)水平与CAC的存在及数量之间的性别特异性关联。
在女性中，在调整年龄、高血压状态、腰围、高低密度脂蛋白胆固醇（LDL-C）的存在情况以及吸烟史后，Lp(a)是CAC存在及数量的显著预测因子（P = 0.0426）。在男性中，在调整年龄、高血压状态、体重指数、高LDL-C的存在情况以及吸烟史后，Lp(a)与吸烟史之间的正相互作用（P = 0.0387）与CAC的存在及数量显著相关。
Lp(a)与CAC之间的性别特异性关系为CAD的性别特异性风险因素分析提供了证据支持。在女性中，单独的Lp(a)可能是冠状动脉粥样硬化的独立危险因素，而在男性中，Lp(a)可能在存在其他危险因素及其水平的条件下赋予更高风险。Lp(a)在亚临床冠状动脉粥样硬化的预测和发病机制中的作用需要进一步阐明。
