Tmoyan N A, Ezhov M V, Afanasieva O I, Klesareva E A, Razova O A, Kukharchuk V V, Pokrovsky S N
A.L. Myasnikov Institute of Clinical Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia, Moscow, Russia.
Institute of Experimental Cardiology FSBI "National Medical Research Center of Cardiology" of MoH of Russia, Moscow, Russia.
Ter Arkh. 2018 Sep 20;90(9):31-36. doi: 10.26442/terarkh201890931-36.
Lipoprotein(a) [Lp(a)] is an independent risk factor of coronary heart disease (CHD) and myocardial infarction. Data about the role of Lp(a) in the development of peripheral artery disease (PAD) is controversial and uncertain. The aim of the study was to evaluate the association between Lp(a), apolipoprotein(a) [apo(a)] phenotypes and PAD.
The study included 998 patients (707 male and 291 female, average age 60±12). The patients were divided into 4 groups depending on the presence or absence PAD and CHD: group I (n=188, PAD+CHD+), group II (n=78, PAD+CHD-), group III (n=407, PAD-CHD+), group IV (n=325, PAD-CHD-).
The level of Lp(a) was significantly higher in groups I, II, III in comparison with patients of control group (group IV): 34 [15; 80], 30 [10; 49], 22 [8; 60] mg/dl vs. 15 [6; 35] mg/dl respectively, p<0.01 in all cases. Lp(a) level was higher in the group I than in the other groups (p<0.05). The prevalence of elevated Lp(a) level (≥ 30 mg/dl) was significantly higher in groups I, II, III than in control group: 54%, 50%, 43% respectively vs. 30%, p<0.01 in all cases. The prevalence of Lp(a) ≥ 30 mg/dl was more frequent in the group with PAD and CHD than in the group with CHD and without PAD (p=0.02). The odds ratio (OR) of PAD in the presence of elevated Lp(a) level was 1.9 (95%CI, 1.4-2.5, p<0.01). Low molecular weight (LMW) apo(a) phenotype was met more frequently in groups I, II, III compared to group IV: 46%, 56%, 52% respectively vs. 28%, p<0.01. LMW apo(a) in the patients without CHD was associated with PAD (OR 3.3; 95% CI, 1.6-6.8, p<0.01), and there was no association with the patients with CHD. In logistic regression analysis adjusted for age, sex, hypertension, obesity, smoking, diabetes, LDL-C, Lp(a) and LMW apo(a) phenotype were independent predictors of PAD when included separately.
Elevated level of Lp(a) and LMW apo(a) phenotype are independent risk factors of PAD. The level of Lp(a) in the patients with PAD and CHD was higher than in the case of isolated lesion of each vascular pool. Higher level of Lp(a) is associated with more severe atherosclerosis involving more than one vascular pools.
脂蛋白(a)[Lp(a)]是冠心病（CHD）和心肌梗死的独立危险因素。关于Lp(a)在周围动脉疾病（PAD）发生发展中的作用的数据存在争议且不明确。本研究的目的是评估Lp(a)、载脂蛋白(a)[apo(a)]表型与PAD之间的关联。
本研究纳入998例患者（男性707例，女性291例，平均年龄60±12岁）。根据是否存在PAD和CHD将患者分为4组：I组（n = 188，PAD+CHD+），II组（n = 78，PAD+CHD-），III组（n = 407，PAD-CHD+），IV组（n = 325，PAD-CHD-）。
与对照组（IV组）患者相比，I、II、III组的Lp(a)水平显著更高：分别为34[15；80]、30[10；49]、22[8；60]mg/dl，而IV组为15[6；35]mg/dl，所有情况均p<0.01。I组的Lp(a)水平高于其他组（p<0.05）。I、II、III组Lp(a)水平升高（≥30mg/dl）的患病率显著高于对照组：分别为54%、50%、43%，而对照组为30%，所有情况均p<0.01。Lp(a)≥30mg/dl在合并PAD和CHD的组中的患病率高于合并CHD但无PAD的组（p = 0.02）。Lp(a)水平升高时PAD的比值比（OR）为1.9（95%CI，1.4 - 2.5，p<0.01）。与IV组相比，I、II、III组中低分子量（LMW）apo(a)表型的出现频率更高：分别为46%、56%、52%，而IV组为28%，p<0.01。无CHD患者中的LMW apo(a)与PAD相关（OR 3.3；95%CI，1.6 - 6.8，p<0.01），而与CHD患者无关。在对年龄、性别、高血压、肥胖、吸烟、糖尿病、低密度脂蛋白胆固醇（LDL-C）进行校正的逻辑回归分析中，Lp(a)和LMW apo(a)表型单独纳入时均是PAD的独立预测因素。
Lp(a)水平升高和LMW apo(a)表型是PAD的独立危险因素。合并PAD和CHD患者的Lp(a)水平高于单一血管池孤立病变的情况。Lp(a)水平越高，与涉及多个血管池的更严重动脉粥样硬化相关。
