Department of Clinical and Experimental Medicine, Unit of Internal Medicine, University of Verona, Verona, Italy.
J Thromb Haemost. 2010 Mar;8(3):463-71. doi: 10.1111/j.1538-7836.2009.03720.x. Epub 2009 Dec 11.
Apolipopoprotein C-III (apo C-III) plays a pivotal role in controlling plasma triglyceride (TG) and contributes to the atherogenic properties of TG-rich lipoproteins.
(i) To examine the predictive value of serum apo C-III for cardiovascular mortality in the setting of secondary prevention of coronary artery disease (CAD); and (ii) to evaluate possible associations between apolipoprotein levels and the thrombin generation assay, a global test to estimate plasma thrombogenic potential.
A cohort of 633 patients with angiographically proven CAD was prospectively followed for a median follow-up of 57 months. The large majority of them (92%) underwent coronary (endovascular or surgical) revascularization. During the follow-up, 91 (14.3%) out of 633 patients died, with 64 events (10.1%) attributed to cardiovascular causes. After adjustment for all the other predictors of mortality during univariate analysis (i.e. age, statin therapy, myocardial infarction history, diabetes, hs-CRP and creatinine), elevated apo C-III levels (> or = 10.5 mg dL(-1)- the median value) significantly predicted both total and cardiovascular mortality (HR for total mortality 2.22 with 95% CI 1.16-4.24; HR for cardiovascular mortality 2.35 with 95% CI 1.19-4.62). In a subgroup of 225 subjects, apo C-III levels were significantly associated with endogenous thrombin potential in regression models (standardized beta coefficient = 0.207, P = 0.002).
Basal concentrations of apo C-III levels > or = 10.5 mg dL(-1) in CAD patients independently predicted cardiovascular mortality during the subsequent 5-year period. Such concentrations were associated with an enhanced plasma endogenous thrombin generation, suggesting a complex interplay between TG-rich particles and the coagulation cascade as well as a new 'thrombogenetic' role for apo C-III.
载脂蛋白 C-III（apo C-III）在控制血浆甘油三酯（TG）方面发挥着关键作用，并有助于富含 TG 的脂蛋白的动脉粥样硬化特性。
（i）检查血清 apo C-III 在冠心病二级预防中的心血管死亡率预测价值；（ii）评估载脂蛋白水平与凝血酶生成试验之间的可能关联，凝血酶生成试验是一种估计血浆血栓生成潜力的全球测试。
前瞻性地对 633 例经血管造影证实的 CAD 患者进行了队列研究，中位随访时间为 57 个月。他们中的绝大多数（92%）接受了冠状动脉（血管内或手术）血运重建。在随访期间，633 例患者中有 91 例（14.3%）死亡，其中 64 例（10.1%）归因于心血管原因。在校正单变量分析中所有其他死亡率预测因素（即年龄、他汀类药物治疗、心肌梗死史、糖尿病、hs-CRP 和肌酐）后，升高的 apo C-III 水平（>或= 10.5 mg/dL-中位数）显著预测总死亡率和心血管死亡率（总死亡率的 HR 为 2.22，95%CI 为 1.16-4.24；心血管死亡率的 HR 为 2.35，95%CI 为 1.19-4.62）。在 225 例亚组患者中，apo C-III 水平与回归模型中的内源性凝血酶潜能显著相关（标准化β系数=0.207，P=0.002）。
CAD 患者基础 apo C-III 水平>或=10.5 mg/dL-独立预测随后 5 年的心血管死亡率。这种浓度与增强的血浆内源性凝血酶生成相关，表明富含 TG 的颗粒与凝血级联之间存在复杂的相互作用，以及 apo C-III 的新“血栓形成”作用。
