Bennet Anna, Di Angelantonio Emanuele, Erqou Sebhat, Eiriksdottir Gudny, Sigurdsson Gunnar, Woodward Mark, Rumley Ann, Lowe Gordon D O, Danesh John, Gudnason Vilmundur
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
Arch Intern Med. 2008 Mar 24;168(6):598-608. doi: 10.1001/archinte.168.6.598.
Large-scale prospective data are needed to determine whether associations between lipoprotein(a) (Lp[a]) and coronary heart disease (CHD) risk are independent of established risk factors, to characterize the shape of this relationship, and to quantify associations in relevant subgroups.
Levels of Lp(a) were measured in samples obtained at baseline from 2047 patients who had first-ever nonfatal myocardial infarction or who died of CHD during the study and from 3921 control participants in the Reykjavik Study (n=18 569), as well as in paired samples obtained 12 years apart from 372 participants to quantify within-person fluctuations.
Baseline Lp(a) levels had little or no correlation with known cardiovascular risk factors, such as age, sex, total cholesterol level, and blood pressure. The Lp(a) values were highly consistent from decade to decade, with a regression dilution ratio (calculated on the log scale) of 0.92 (95% confidence interval, 0.85-0.99). The odds ratio for CHD, unaltered after adjustment for several established risk factors (age, sex, smoking status, blood pressure, total cholesterol, triglycerides level, diabetes mellitus, and body mass index), was 1.60 (95% confidence interval, 1.38-1.85) in a comparison of extreme thirds of baseline Lp(a) levels. Odds ratios were progressively higher with increasing Lp(a) levels and did not vary materially by several individual- or study-level characteristics.
There are independent, continuous associations between Lp(a) levels and risk of future CHD in a broad range of individuals. Levels of Lp(a) are highly stable within individuals across many years and are only weakly correlated with known risk factors. Further assessment of their possible role in CHD prevention is warranted.
需要大规模前瞻性数据来确定脂蛋白(a)[Lp(a)]与冠心病(CHD)风险之间的关联是否独立于既定风险因素，描述这种关系的形式，并量化相关亚组中的关联。
在雷克雅未克研究（n = 18569）中，对2047例首次发生非致命性心肌梗死或在研究期间死于冠心病的患者以及3921例对照参与者的基线样本进行Lp(a)水平测量，并对372例参与者相隔12年采集的配对样本进行测量，以量化个体内波动情况。
基线Lp(a)水平与年龄、性别、总胆固醇水平和血压等已知心血管风险因素几乎没有相关性。Lp(a)值在十年间高度一致，回归稀释比（对数尺度计算）为0.92（95%置信区间，0.85 - 0.99）。在比较基线Lp(a)水平的极端三分位数时，在对年龄、性别、吸烟状况、血压、总胆固醇、甘油三酯水平、糖尿病和体重指数等多个既定风险因素进行调整后，冠心病的比值比为1.60（95%置信区间，1.38 - 1.85）。随着Lp(a)水平升高，比值比逐渐升高，且在多个个体或研究水平特征方面没有实质性差异。
在广泛个体中，Lp(a)水平与未来冠心病风险之间存在独立的连续关联。Lp(a)水平在个体内多年来高度稳定，且与已知风险因素仅有微弱关联。有必要进一步评估其在冠心病预防中的可能作用。
