Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan.
Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
Eur Heart J Cardiovasc Imaging. 2016 May;17(5):492-7. doi: 10.1093/ehjci/jev338. Epub 2016 Jan 12.
Lipoprotein(a) (Lp(a)) levels have been associated with aortic valvular calcification and stenosis. The prevalence and risk factors, including Lp(a) level, for valvular heart disease (VHD) were investigated in patients with peripheral arterial disease (PAD).
Echocardiography was performed in 861 patients with PAD to detect abnormal cardiac findings. Relationships between VHD and risk factors were analysed. The prevalence of VHD was 43.6%, and the prevalences of aortic valve regurgitation (AR), mitral valve regurgitation (MR), aortic valve stenosis (AS), mitral valve stenosis (MS), and tricuspid regurgitation (TR) were 26.8, 19.7, 5.9, 1.3, and 9.4%, respectively. In stepwise multiple regression analysis, severity of AR was related to age, albumin, and estimated glomerular filtration rate (eGFR); MR was related to eGFR and age; AS was related to eGFR, Lp(a), and age; MS was related to Lp(a) and female gender; and TR was related to age, body mass index, and total cholesterol (all P < 0.05). Lp(a) level was higher in patients with AS compared with those without AS [34.0 (16.7-50.0) vs. 20.0 (11.0-35.0) mg/dL, P = 0.002], in patients with MS compared with those without MS [37.0 (21.5-77.3) vs. 21.0 (11.0-35.0), P = 0.037], and in patients with AS and/or MS compared with those without AS and MS [34.0 (17.3-50.0) vs. 20.0 (11.0-35.0), P = 0.001]. Lp(a) levels were related to low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels (P = 0.004).
The high prevalence of VHD is found, especially in AR and MR, and the Lp(a) level is associated with increased risks of AS and MS in patients with PAD.
脂蛋白（a）（Lp(a)）水平与主动脉瓣钙化和狭窄有关。本研究旨在探讨外周动脉疾病（PAD）患者中瓣膜性心脏病（VHD）的患病率和危险因素，包括 Lp(a)水平。
对 861 例 PAD 患者进行超声心动图检查，以检测异常心脏发现。分析 VHD 与危险因素之间的关系。VHD 的患病率为 43.6%，主动脉瓣反流（AR）、二尖瓣反流（MR）、主动脉瓣狭窄（AS）、二尖瓣狭窄（MS）和三尖瓣反流（TR）的患病率分别为 26.8%、19.7%、5.9%、1.3%和 9.4%。逐步多元回归分析显示，严重 AR 与年龄、白蛋白和估算肾小球滤过率（eGFR）有关；MR 与 eGFR 和年龄有关；AS 与 eGFR、Lp(a)和年龄有关；MS 与 Lp(a)和女性有关；TR 与年龄、体重指数和总胆固醇有关（均 P < 0.05）。与无 AS 患者相比，AS 患者的 Lp(a)水平更高[34.0（16.7-50.0）比 20.0（11.0-35.0）mg/dL，P = 0.002]，MS 患者的 Lp(a)水平更高[37.0（21.5-77.3）比 21.0（11.0-35.0）mg/dL，P = 0.037]，AS 和/或 MS 患者的 Lp(a)水平更高[34.0（17.3-50.0）比 20.0（11.0-35.0）mg/dL，P = 0.001]。Lp(a)水平与低密度脂蛋白胆固醇和高敏 C 反应蛋白水平相关（P = 0.004）。
PAD 患者中 VHD 的高患病率，尤其是 AR 和 MR，且 Lp(a)水平与 AS 和 MS 风险增加有关。
