Tselmin S, Julius U, Müller G, Fischer S, Bornstein S R
Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.
Atheroscler Suppl. 2009 Dec 29;10(5):79-84. doi: 10.1016/S1567-5688(09)71817-3.
The role of lipoprotein (a) (Lp(a)) in atherogenesis has been previously demonstrated in several trials reporting various and sometimes contradictory findings. Our retrospective study analyzed the incidence of cardiovascular events in patients with Lp(a) plasma level of more than 250 mg/l, which has been defined as a threshold in previous publications.
The files of 303 patients with Lp(a) of more than 250 mg/l were divided into 5 groups categorized by Lp(a) level increase and reviewed regarding age, sex, BMI, dyslipidemias, arterial hypertension, diabetes mellitus, family history of cardiovascular events, fatty liver and incidence of vascular events in coronaries, carotids and lower extremities.
No significant differences were observed with respect to sex, age, BMI, dyslipidemias, diabetes mellitus, arterial hypertension and hepatic steatosis. The likely occurrence of at least one event was 2.77 times more in the fourth (Lp(a) 1235 +/- 82 mg/l) and 6.2 times more in the fifth (Lp(a) 2068 +/- 471 mg/l) than in the first group (Lp(a) 322 +/- 48 mg/l). The 5 groups differed with respect to average "events per patient" (p < 0.001). The magnitude of increased Lp (a) exceeded that of other risk factors.
A substantially (more than 1100 mg/l) elevated Lp(a) plasma level seems to be an important predictor for the occurrence of cardiovascular events. It makes sense in clinical practice to consider patients exhibiting this elevation as having a high cardiovascular risk. In case of progression of atherosclerotic complications the patients should be assigned for lipid apheresis.
脂蛋白(a)[Lp(a)]在动脉粥样硬化形成中的作用先前已在多项试验中得到证实，这些试验报告了各种不同且有时相互矛盾的结果。我们的回顾性研究分析了血浆Lp(a)水平超过250mg/l的患者发生心血管事件的发生率，这一水平在先前的出版物中已被定义为一个阈值。
将303例Lp(a)超过250mg/l的患者档案按Lp(a)水平升高分为5组，并就年龄、性别、体重指数、血脂异常、动脉高血压、糖尿病、心血管事件家族史、脂肪肝以及冠状动脉、颈动脉和下肢血管事件的发生率进行回顾分析。
在性别、年龄、体重指数、血脂异常、糖尿病、动脉高血压和肝脂肪变性方面未观察到显著差异。与第一组（Lp(a) 322±48mg/l）相比，第四组（Lp(a) 1235±82mg/l）至少发生一次事件的可能性高2.77倍，第五组（Lp(a) 2068±471mg/l）高6.2倍。5组在平均“每位患者的事件数”方面存在差异（p<0.001）。Lp(a)升高的幅度超过了其他危险因素。
Lp(a)血浆水平大幅升高（超过1100mg/l）似乎是心血管事件发生的重要预测指标。在临床实践中，将出现这种升高的患者视为具有高心血管风险是合理的。如果动脉粥样硬化并发症进展，应安排患者进行血脂分离治疗。
