State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Cardiovasc Diabetol. 2020 Jul 9;19(1):111. doi: 10.1186/s12933-020-01083-8.
Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs.
From April 2011 to March 2017, we consecutively recruited 2284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan-Meier, Cox regression and C-statistic analyses were performed.
During 7613 patient-years' follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p = 0.002). Kaplan-Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (< 7.0%; ≥ 7.0%, both p < 0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049 (1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): < 7.0%, 2.009 (1.051-3.840); ≥ 7.0%, 2.162 (1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model.
Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
合并研究报告称，脂蛋白(a)[Lp(a)]与 2 型糖尿病（T2DM）患者冠状动脉疾病（CAD）的不良结局相关。然而，在有 T2DM 和既往心血管事件（CVE）的患者中，Lp(a)对复发性心血管事件（CVE）的预后重要性目前尚不确定。
我们于 2011 年 4 月至 2017 年 3 月连续招募了 2284 例有既往 CVE 的 T2DM 患者。根据 Lp(a)水平将患者分为低、中、高组，并随访复发性 CVE，包括非致死性急性心肌梗死、卒中和心血管死亡率。进行 Kaplan-Meier、Cox 回归和 C 统计分析。
在 7613 患者年的随访期间，发生了 153 例复发性 CVE。与无事件组相比，发生 CVE 的患者 Lp(a)水平显著升高（20.44 比 14.71mg/dL，p=0.002）。Kaplan-Meier 分析显示，无论 HBA1c 状态如何（<7.0%；≥7.0%，均 p<0.05），高和中 Lp(a)组的无事件生存率明显低于低 Lp(a)组。此外，多变量 Cox 回归模型表明，Lp(a)与复发性 CVE 的高风险独立相关[HR（95%CI）：2.049（1.308-3.212）]，这些数据在不同的 HBA1c 状态下仍然存在（HR（95%CI）：<7.0%，2.009（1.051-3.840）；≥7.0%，2.162（1.148-4.073））。此外，当将 Lp(a)添加到 Cox 模型中时，C 统计量的结果显著提高了 0.029。
我们的数据首次证实，Lp(a)是 T2DM 患者既往 CVE 后复发性 CVE 的独立预测因子，表明 Lp(a)测量可能有助于 T2DM 患者首次发生 CVE 后进一步进行风险分层。
