Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany.
Atherosclerosis. 2013 Aug;229(2):531-40. doi: 10.1016/j.atherosclerosis.2013.04.015. Epub 2013 May 3.
Coronary atherosclerosis can be detected by computed tomography. The amount of coronary artery calcification (CAC) is related to cardiovascular risk factors, the strength of the gender specific relation between lipoprotein parameters and CAC has not extensively been studied. Especially, the role of routinely determined lipoproteins in contrast to less common and computed lipid parameters (e.g. ratios) remains to be clarified.
The study cohort (n = 3956, 52% women, age 45-75 years) was randomly selected from three cities of a German metropolitan area. Lipoproteins-low-and high density lipoprotein (LDL-C/HDL-C), total cholesterol, apolipoprotein A-1 and B (apoA-1/apoB) as well as lipoprotein (a) (Lp(a)) were measured, while non-HDL-C was calculated. All participants received an electron-beam computed tomography (EBCT) for quantification of CAC. Adjusted for age and cardiovascular risk factors, CAC increased by a factor of 1.97 (1.51-2.57, 95% CI) and 1.94 (1.53-2.45, 95% CI) comparing the fourth to the first quartile of LDL-C for men and women, respectively. This association with LDL-C was also found after dichotomization of CAC at thresholds >0, ≥ 100 and ≥ 400. The best association of CAC was, however, found to be apoB and the second best was non HDL-C, in both men and women. For apoB, the model including all risk factors reached an explained variance for CAC of 20.2% in men and of 21.6% in women. When using LDL-C as a given parameter according to the current practice and advice, HDL-C in men and apoB in women provided an additional but small benefit.
ApoB showed the best association with CAC compared to all other tested lipoproteins. Neither the ratio LDL-C/HDL-C nor apoB/apoA-1, or Lp(a) revealed a closer association with CAC. While lipoproteins are related to CAC more closely in women than in men, their association with CAC is, however, not particularly strong. Our results may influence primary and secondary prevention advices in order to improve detection of subclinical atherosclerosis, for which lipoprotein parameters can only play a minor role.
冠状动脉粥样硬化可以通过计算机断层扫描（CT）检测到。冠状动脉钙化（CAC）的程度与心血管危险因素有关，脂蛋白参数与 CAC 之间的性别特异性关系强度尚未得到广泛研究。特别是，在常规确定的脂蛋白与不太常见的计算脂质参数（例如比值）相比，其作用仍有待阐明。
研究队列（n=3956，女性占 52%，年龄 45-75 岁）是从德国大都市地区的三个城市中随机选择的。测量了脂蛋白-低和高密度脂蛋白（LDL-C/HDL-C）、总胆固醇、载脂蛋白 A-1 和 B（apoA-1/apoB）以及脂蛋白（a）（Lp(a)），而非高密度脂蛋白胆固醇（non-HDL-C）是计算得出的。所有参与者均接受电子束计算机断层扫描（EBCT）以定量 CAC。调整年龄和心血管危险因素后，与 LDL-C 第 1 四分位数相比，男性和女性的 CAC 分别增加了 1.97 倍（95%CI：1.51-2.57）和 1.94 倍（95%CI：1.53-2.45）。在将 CAC 二值化为>0、≥100 和≥400 时，也发现了与 LDL-C 的这种关联。然而，在男性和女性中，与 CAC 相关性最好的是 apoB，其次是非高密度脂蛋白胆固醇。对于 apoB，纳入所有危险因素的模型对男性 CAC 的解释方差达到 20.2%，对女性达到 21.6%。当根据当前实践和建议将 LDL-C 作为给定参数使用时，男性的 HDL-C 和女性的 apoB 提供了额外但较小的益处。
与其他测试的脂蛋白相比，apoB 与 CAC 的相关性最好。LDL-C/HDL-C 比值或 apoB/apoA-1 比值或 Lp(a) 均与 CAC 无密切关联。尽管脂蛋白与女性 CAC 的相关性比男性更密切，但它们与 CAC 的相关性并不特别强。我们的研究结果可能会影响一级和二级预防建议，以改善亚临床动脉粥样硬化的检测，因为脂蛋白参数只能发挥次要作用。
