Leon H. Charney Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY, USA.
Leon H. Charney Division of Cardiology, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York, NY, USA.
J Clin Lipidol. 2017 Sep-Oct;11(5):1177-1180. doi: 10.1016/j.jacl.2017.07.005. Epub 2017 Jul 22.
Lipoprotein(a) [Lp(a)] is an inherited atherogenic lipoprotein and an independent risk factor for atherosclerotic cardiovascular disease; however, its clinical role remains limited.
We hypothesized that Lp(a) screening in high cardiovascular risk patients could provide insight into disease pathogenesis and modify physician behavior for treatment intensification targeting traditional risk factors when Lp(a)-related risk was identified.
We screened 113 patients presenting electively for percutaneous coronary intervention (PCI) for Lp(a) who met any of the following criteria: (1) premature coronary artery disease (male age <55 years, female age <65 years); (2) family history of premature coronary artery disease; (3) progression to PCI despite well-controlled traditional risk factors (blood pressure <140/90 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL, and HbA1c <7%, and nonsmoker); or (4) progression to PCI despite at least moderate intensity statin use (simvastatin 40, atorvastatin 40-80, or rosuvastatin 20-40 mg daily).
In this high-risk cohort, Lp(a) was elevated in nearly half of all subjects, including those with seemingly well-controlled lipids by prior guidelines, suggesting a role for Lp(a) in conferring residual cardiovascular risk. In our cohort, when screened positive, knowledge of an elevated Lp(a) did not influence referring physicians' treatment intensification targeting traditional modifiable cardiovascular risk factors (P = .18).
When screened judiciously, elevated levels of Lp(a) are highly prevalent in high cardiovascular risk patients, including at a young age, presenting for PCI and may contribute to previously unappreciated residual cardiovascular risk.
脂蛋白(a)[Lp(a)]是一种遗传性动脉粥样硬化脂蛋白，是动脉粥样硬化性心血管疾病的独立危险因素；然而，其临床作用仍然有限。
我们假设，在高心血管风险患者中进行 Lp(a)筛查，可以深入了解疾病的发病机制，并在识别与 Lp(a)相关的风险时，改变医生针对传统危险因素进行治疗强化的行为。
我们对 113 名选择性行经皮冠状动脉介入治疗（PCI）的患者进行了 Lp(a)筛查，这些患者符合以下标准之一：（1）早发冠心病（男性年龄<55 岁，女性年龄<65 岁）；（2）早发冠心病家族史；（3）尽管传统危险因素得到良好控制（血压<140/90mmHg，低密度脂蛋白胆固醇<100mg/dL，糖化血红蛋白<7%，不吸烟），但仍进展至 PCI；或（4）尽管至少使用中等强度他汀类药物（辛伐他汀 40mg，阿托伐他汀 40-80mg，或瑞舒伐他汀 20-40mg 每日），但仍进展至 PCI。
在这一高危队列中，近一半的患者 Lp(a)升高，包括那些根据先前的指南血脂控制良好的患者，这表明 Lp(a)在产生残余心血管风险方面起作用。在我们的队列中，当筛查阳性时，升高的 Lp(a)水平并不会影响被转诊医生针对传统可改变心血管危险因素的治疗强化（P=0.18）。
当谨慎筛选时，在高心血管风险患者中，包括年轻患者、接受 PCI 的患者，升高的 Lp(a)水平高度普遍存在，并且可能导致以前未被重视的残余心血管风险。
