Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Endocrinology, Austin Health, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia.
Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Endocrinology, Austin Health, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia.
Heart Lung Circ. 2020 Nov;29(11):1682-1687. doi: 10.1016/j.hlc.2020.03.005. Epub 2020 Apr 1.
Elevated lipoprotein(a) (Lp(a)) is an inherited lipid disorder and an independent risk factor for cardiovascular (CV) disease. Although its prevalence in the general population has been well-documented, the prevalence of elevated Lp(a) in patients with clinical coronary artery disease (CAD) is less clear. In this study, we hypothesised that there is an over-representation of elevated Lp(a) in patients with early-onset CAD compared to the general population.
Between 6 February and 8 June 2018, we screened consecutive patients aged ≤70 years who presented to the Austin Hospital with any of the following criteria: (1) acute coronary syndrome (ACS); (2) percutaneous coronary intervention (PCI); or (3) coronary artery bypass grafting (CABG). Whilst examining a range of different Lp(a) levels, a dichotomous elevated Lp(a) was defined as concentrations ≥0.5 g/L. Other CV risk factors were documented including hypertension, type 2 diabetes mellitus, and familial hypercholesterolaemia (FH) using the Dutch Lipid Clinic Network Criteria (DLCNC), also incorporating family history and clinical examination.
One hundred and fifty-eight (158) patients were screened; 63 (39.9%) were under 60 years of age. Overall, elevated Lp(a) ≥0.5 g/L was identified in 57 patients (36.1%). Of these, nine patients (15.8%) also had probable or definite FH. General population data was obtained from the Copenhagen General Population Study which studied 6,000 men and women and showed that the estimated prevalence of Lp(a) ≥0.5 g/L in the general population was 20%.
Elevated Lp(a) is more prevalent in patients with relatively early-onset CAD compared to the general population and may contribute to previously unappreciated residual cardiovascular risk. Patients who present with early-onset CAD, should be routinely screened for elevated Lp(a).
脂蛋白(a)（Lp(a)）升高是一种遗传性脂质紊乱，也是心血管疾病（CV）的独立危险因素。尽管其在普通人群中的患病率已有充分记录，但患有临床冠状动脉疾病（CAD）的患者中升高的 Lp(a)患病率尚不清楚。在这项研究中，我们假设与普通人群相比，早发性 CAD 患者中升高的 Lp(a) 比例过高。
在 2018 年 2 月 6 日至 6 月 8 日期间，我们对连续就诊于奥斯汀医院的≤70 岁以下的患者进行了筛查，这些患者具有以下标准之一：（1）急性冠脉综合征（ACS）；（2）经皮冠状动脉介入治疗（PCI）；或（3）冠状动脉旁路移植术（CABG）。在检查一系列不同的 Lp(a)水平时，将浓度≥0.5 g/L 的二分类升高的 Lp(a)定义为升高的 Lp(a)。使用荷兰血脂诊所网络标准（DLCNC）记录其他心血管危险因素，包括高血压、2 型糖尿病和家族性高胆固醇血症（FH），还包括家族史和临床检查。
共筛查了 158 例患者；其中 63 例（39.9%）年龄小于 60 岁。总体而言，57 例患者（36.1%）的 Lp(a)≥0.5 g/L 升高。其中，9 例（15.8%）患者也可能或明确患有 FH。一般人群的数据来自哥本哈根一般人群研究，该研究共研究了 6000 名男性和女性，估计一般人群中 Lp(a)≥0.5 g/L 的患病率为 20%。
与普通人群相比，患有相对早发性 CAD 的患者中升高的 Lp(a)更为普遍，这可能导致以前未被认识到的残余心血管风险。有早发性 CAD 病史的患者应常规筛查升高的 Lp(a)。
