Department of Internal Medicine, Hospital Universitario San Pedro de Alcántara de Cáceres, Cáceres, Spain.
Department of Nursing, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain.
Atherosclerosis. 2018 Sep;276:10-14. doi: 10.1016/j.atherosclerosis.2018.07.001. Epub 2018 Jul 4.
Although genetic and epidemiological studies support that people with high lipoprotein (a) [Lp(a)] levels are at an increased risk for arterial disease, its prognostic value in patients with established artery disease has not been consistently evaluated.
FRENA is a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We assessed the risk for subsequent myocardial infarction, ischemic stroke or limb amputation according to Lp(a) levels at baseline.
As of December 2016, 1503 stable outpatients were recruited. Of these, 814 (54%) had levels <30 mg/dL, 319 (21%) had 30-50 mg/dL and 370 (25%) had ≥50 mg/dL. Over a mean follow-up of 36 months, 294 patients developed subsequent events (myocardial infarction 122, ischemic stroke 114, limb amputation 58) and 85 died. On multivariable analysis, patients with Lp(a) levels of 30-50 mg/dL were at a higher risk for myocardial infarction (hazard ratio [HR]: 4.67; 95%CI: 2.77-7.85), ischemic stroke (HR: 8.27; 95%CI: 4.14-16.5) or limb amputation (HR: 3.18; 95%CI: 1.36-7.44) than those with normal levels. Moreover, patients with levels ≥50 mg/dL were at increased risk for myocardial infarction (HR: 19.5; 95%CI: 10.5-36.1), ischemic stroke (HR: 54.5; 95%CI: 25.4-116.7) or limb amputation (HR: 22.7; 95%CI: 9.38-54.9).
Stable outpatients with symptomatic artery disease and Lp(a) levels >30 mg/dL were at a 5-fold higher risk for subsequent myocardial infarction, stroke or limb amputation. Those with levels >50 mg/dL were at an over 10-fold higher risk.
尽管遗传和流行病学研究支持高脂蛋白(a)[Lp(a)]水平的人患动脉疾病的风险增加，但它在已确诊动脉疾病患者中的预后价值尚未得到一致评估。
FRENA 是一项连续门诊患者的前瞻性登记研究，包括冠状动脉、脑血管或外周动脉疾病患者。我们根据基线时的 Lp(a)水平评估随后发生心肌梗死、缺血性卒中和肢体截肢的风险。
截至 2016 年 12 月，共招募了 1503 名稳定的门诊患者。其中，814 名（54%）患者的 Lp(a)水平<30mg/dL，319 名（21%）患者的 Lp(a)水平为 30-50mg/dL，370 名（25%）患者的 Lp(a)水平≥50mg/dL。在平均 36 个月的随访期间，294 名患者发生了后续事件（心肌梗死 122 例，缺血性卒 114 例，肢体截肢 58 例），85 名患者死亡。多变量分析显示，Lp(a)水平为 30-50mg/dL 的患者发生心肌梗死（风险比[HR]：4.67；95%CI：2.77-7.85）、缺血性卒（HR：8.27；95%CI：4.14-16.5）或肢体截肢（HR：3.18；95%CI：1.36-7.44）的风险高于 Lp(a)水平正常的患者。此外，Lp(a)水平≥50mg/dL 的患者发生心肌梗死（HR：19.5；95%CI：10.5-36.1）、缺血性卒（HR：54.5；95%CI：25.4-116.7）或肢体截肢（HR：22.7；95%CI：9.38-54.9）的风险更高。
有症状动脉疾病且 Lp(a)水平>30mg/dL 的稳定门诊患者发生后续心肌梗死、卒中和肢体截肢的风险增加 5 倍。Lp(a)水平>50mg/dL 的患者风险增加 10 倍以上。
