Agarwala Anandita, Pokharel Yashashwi, Saeed Anum, Sun Wensheng, Virani Salim S, Nambi Vijay, Ndumele Chiadi, Shahar Eyal, Heiss Gerardo, Boerwinkle Eric, Konety Suma, Hoogeveen Ron C, Ballantyne Christie M
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
Atherosclerosis. 2017 Jul;262:131-137. doi: 10.1016/j.atherosclerosis.2017.05.014. Epub 2017 May 12.
Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF.
Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987-1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups.
At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.09-1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95% CI 0.91-1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters.
Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.
脂蛋白(a)[Lp(a)]是一种促动脉粥样硬化脂蛋白，与冠心病、缺血性中风以及最近的主动脉瓣狭窄和心力衰竭(HF)相关。我们在社区动脉粥样硬化风险(ARIC)研究中检验了Lp(a)水平与HF住院发生率之间的关联。我们还评估了Lp(a)水平与动脉僵硬度之间的关系，将其作为HF发生的一种潜在机制。
在ARIC第1次访视(1987 - 1989年)时，对14154名无HF病史的ARIC参与者进行Lp(a)检测。使用Cox比例风险模型评估Lp(a)五分位数与HF住院发生率之间的关联。根据Lp(a)五分位数对动脉僵硬度参数进行分层，并计算有序组间的p趋势。
在中位随访23.4年期间，有2605例HF住院病例。在对年龄、种族、性别、收缩压、高血压病史、糖尿病、吸烟状况、体重指数、心率和高密度脂蛋白胆固醇进行校正的模型中，Lp(a)水平与HF住院发生率直接相关(五分位数5与五分位数1相比：风险比[HR]1.24，95%置信区间[CI]1.09 - 1.41；五分位数增加时的p趋势<0.01)，但在排除现患和新发心肌梗死病例后则无相关性(HR 1.07，95% CI 0.91 - 1.27；p趋势 = 0.70)。在对年龄、性别和种族进行校正后，Lp(a)五分位数与动脉僵硬度参数无显著相关性。
Lp(a)水平升高与HF住院风险增加相关。排除现患和新发心肌梗死病例后，这种关联不再显著。Lp(a)水平与动脉僵硬度参数无关。
