Division of Pharmacology Vascular and Metabolic Diseases, Department of Internal Medicine, Rotterdam, The Netherlands.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Intern Med. 2015 Aug;278(2):166-73. doi: 10.1111/joim.12335. Epub 2015 Jan 5.
Lipoprotein(a) [Lp(a)] is an independent risk factor for aortic valve stenosis and aortic valve calcification (AVC) in the general population. In this study, we determined the association between AVC and both plasma Lp(a) levels and apolipoprotein(a) [apo(a)] kringle IV repeat polymorphisms in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH).
A total of 129 asymptomatic heterozygous FH patients (age 40-69 years) were included in this study. AVC was detected using computed tomography scanning. Lp(a) concentration and apo(a) kringle IV repeat number were measured using immunoturbidimetry and immunoblotting, respectively. Univariate and multivariate logistic regression were used to assess the association between Lp(a) concentration and the presence of AVC.
Aortic valve calcification was present in 38.2% of patients, including three with extensive AVC (>400 Agatston units). Lp(a) concentration was significantly correlated with gender, number of apo(a) kringle IV repeats and the presence and severity of AVC, but not with coronary artery calcification (CAC). AVC was significantly associated with plasma Lp(a) level, age, body mass index, blood pressure, duration of statin use, cholesterol-year score and CAC score. After adjustment for all significant covariables, plasma Lp(a) concentration remained a significant predictor of AVC, with an odds ratio per 10-mg dL(-1) increase in Lp(a) concentration of 1.11 (95% confidence interval 1.01-1.20, P = 0.03).
In asymptomatic statin-treated FH patients, plasma Lp(a) concentration is an independent risk indicator for AVC.
载脂蛋白(a)[Lp(a)]是普通人群中主动脉瓣狭窄和主动脉瓣钙化（AVC）的独立危险因素。在这项研究中，我们确定了无症状他汀类药物治疗的杂合家族性高胆固醇血症（FH）患者的 AVC 与血浆 Lp(a)水平和载脂蛋白(a)[apo(a)]Kringle IV 重复多态性之间的关系。
本研究共纳入 129 例无症状杂合 FH 患者（年龄 40-69 岁）。使用计算机断层扫描检测 AVC。使用免疫比浊法和免疫印迹法分别测量 Lp(a)浓度和 apo(a)Kringle IV 重复数。使用单变量和多变量逻辑回归评估 Lp(a)浓度与 AVC 存在之间的关系。
38.2%的患者存在主动脉瓣钙化，其中 3 例为广泛 AVC（>400Agatston 单位）。Lp(a)浓度与性别、apo(a)Kringle IV 重复数以及 AVC 的存在和严重程度显著相关，但与冠状动脉钙化（CAC）无关。AVC 与血浆 Lp(a)水平、年龄、体重指数、血压、他汀类药物使用时间、胆固醇年评分和 CAC 评分显著相关。在校正所有显著协变量后，血浆 Lp(a)浓度仍然是 AVC 的显著预测因子，Lp(a)浓度每增加 10-mg/dL，比值比为 1.11（95%置信区间 1.01-1.20，P=0.03）。
在无症状他汀类药物治疗的 FH 患者中，血浆 Lp(a)浓度是 AVC 的独立危险因素。
