Department of Neurology, Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY, USA.
Cerebrovasc Dis. 2010 Aug;30(3):237-43. doi: 10.1159/000319065. Epub 2010 Jul 23.
Elevated lipoprotein(a) [Lp(a)] is associated with ischemic stroke (IS) among Whites, but data is sparse for non-White populations.
Using a population-based case-control study design with subjects from the Northern Manhattan Stroke Study, we assessed whether Lp(a) levels were independently associated with IS risk among Whites, Blacks and Hispanics.
Lp(a) levels were measured in 317 IS cases (mean age 69 +/- 13 years; 56% women; 16% Whites, 31% Blacks and 52% Hispanics) and 413 community-based controls, matched by age, race/ethnicity and gender. In-person assessments included demographics, socioeconomic status, presence of vascular risk factors and fasting lipid levels. Logistic regression was used to determine the independent association of Lp(a) and IS. Stratified analyses investigated gender and race/ethnic differences.
Mean Lp(a) levels were greater among cases than controls (46.3 +/- 41.0 vs. 38.9 +/- 38.2 mg/dl; p < 0.01). After adjusting for stroke risk factors (hypertension, diabetes mellitus, coronary artery disease, cigarette smoking), lipid levels, and socioeconomic status, Lp(a) levels > or =30 mg/dl were independently associated with an increased stroke risk in the overall cohort (adjusted odds ratio, OR, 1.8, 95% confidence interval, CI, 1.20-2.6; p = 0.004). There was a significant linear dose-response relationship between Lp(a) levels and IS risk. The association between IS risk and Lp(a) > or =30 mg/dl was more pronounced among men (adjusted OR 2.0, 95% CI 1.1-3.5; p = 0.02) and among Blacks (adjusted OR 2.7, 95% CI 1.2-6.2; p = 0.02).
Elevated Lp(a) levels were significantly and independently associated with increased stroke risk, suggesting that Lp(a) is a risk factor for IS across White, Black and Hispanic race/ethnic groups.
载脂蛋白(a)[Lp(a)]升高与白人缺血性脑卒中（IS）相关，但非白人人群的数据较为匮乏。
本研究采用基于人群的病例对照研究设计，以北方曼哈顿卒中研究中的受试者为研究对象，评估 Lp(a)水平是否与白人、黑人和西班牙裔人群的 IS 风险独立相关。
在 317 例 IS 病例（平均年龄 69 +/- 13 岁；56%为女性；16%为白人，31%为黑人，52%为西班牙裔）和 413 例社区匹配对照者中测量了 Lp(a)水平，匹配因素包括年龄、种族/民族和性别。面对面评估包括人口统计学、社会经济状况、血管危险因素和空腹血脂水平。采用 logistic 回归确定 Lp(a)与 IS 的独立关联。分层分析调查了性别和种族/民族差异。
病例组的平均 Lp(a)水平高于对照组（46.3 +/- 41.0 vs. 38.9 +/- 38.2 mg/dl；p < 0.01）。在校正了卒中危险因素（高血压、糖尿病、冠状动脉疾病、吸烟）、血脂水平和社会经济状况后，Lp(a)水平>或=30 mg/dl 与总体队列中卒中风险增加独立相关（校正比值比，OR，1.8，95%置信区间，CI，1.20-2.6；p = 0.004）。Lp(a)水平与 IS 风险之间存在显著的线性剂量反应关系。Lp(a) >或=30 mg/dl 与 IS 风险之间的关联在男性中更为显著（校正 OR 2.0，95%CI 1.1-3.5；p = 0.02），在黑人中更为显著（校正 OR 2.7，95%CI 1.2-6.2；p = 0.02）。
升高的 Lp(a)水平与卒中风险显著独立相关，提示 Lp(a)是白人、黑人和西班牙裔人群缺血性卒中的危险因素。
