Costello Briana T, Silverman Eric R, Doukky Rami, Braun Lynne T, Aggarwal Neelum T, Deng Youping, Li Yan, Lundberg Gina, Williams Kim A, Volgman Annabelle S
Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
Clin Cardiol. 2016 Feb;39(2):96-102. doi: 10.1002/clc.22500. Epub 2016 Feb 16.
Approximately 20% of the population has elevated circulating levels of lipoprotein(a) (Lp[a]), one of the most robust predictors of cardiovascular disease risk. This is particularly true for women.
Many female patients with "normal" traditional risk factors or low atherosclerotic cardiovascular disease (ASCVD) risk scores may harbor high risk related to elevated levels of Lp(a).
A retrospective, cross-sectional study of consecutive female patients presenting to Heart Centers for Women was performed. Discordance between low-density lipoprotein cholesterol (LDL-C) and Lp(a) was determined. The ASCVD risk and Reynolds Risk Score models A (RRS-A) and B (RRS-B) were calculated, and level of agreement in patients meeting treatment threshold (≥7.5% for ASCVD, ≥10% for RRS-A and RRS-B) were compared.
Among 713 women, 290 (41%) had elevated Lp(a); however, LDL-C and Lp(a) were weakly correlated (r = 0.08). Significant discordance was observed between abnormal LDL-C and Lp(a) levels (McNemar P = 0.03). There was moderate correlation between RRS-A and ASCVD risk (r = 0.71, P < 0.001), and Bland-Altman plot showed diminished correlation with increased risk. More patients met treatment threshold by ASCVD risk estimation, but nearly 1 out of 20 patients met treatment threshold by RRS-A but not ASCVD score.
There is high prevalence of elevated Lp(a) among women presenting to Heart Centers for Women. Although traditional risk markers such as elevated LDL-C or high ASCVD risk may be absent in some women, elevated Lp(a) may identify patients who may benefit from aggressive risk-factor modification and pharmacologic therapy.
约20%的人群循环脂蛋白(a)[Lp(a)]水平升高，Lp(a)是心血管疾病风险最强有力的预测指标之一。女性尤其如此。
许多具有“正常”传统风险因素或低动脉粥样硬化性心血管疾病（ASCVD）风险评分的女性患者可能因Lp(a)水平升高而具有高风险。
对连续就诊于女性心脏中心的女性患者进行了一项回顾性横断面研究。确定了低密度脂蛋白胆固醇（LDL-C）和Lp(a)之间的不一致性。计算了ASCVD风险以及雷诺兹风险评分模型A（RRS-A）和B（RRS-B），并比较了达到治疗阈值（ASCVD≥7.5%，RRS-A和RRS-B≥10%）的患者中的一致性水平。
在713名女性中，290名（41%）Lp(a)水平升高；然而，LDL-C与Lp(a)呈弱相关（r = 0.08）。LDL-C异常与Lp(a)水平之间存在显著不一致（麦克内马尔检验P = 0.03）。RRS-A与ASCVD风险之间存在中度相关性（r = 0.71，P < 0.001），布兰德-奥特曼图显示随着风险增加相关性降低。通过ASCVD风险评估有更多患者达到治疗阈值，但近20名患者中有1名通过RRS-A达到治疗阈值但未通过ASCVD评分。
就诊于女性心脏中心的女性中Lp(a)水平升高的患病率很高。尽管一些女性可能没有如LDL-C升高或高ASCVD风险等传统风险标志物，但Lp(a)水平升高可能识别出可能从积极的风险因素调整和药物治疗中获益的患者。
