State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Insititute of Jianghan University, XianZheng Street 122, Wuhan, 430050, China.
Atherosclerosis. 2020 Nov;312:54-59. doi: 10.1016/j.atherosclerosis.2020.08.033. Epub 2020 Sep 8.
Compared with what is known about the prognostic value of lipoprotein(a) [Lp(a)] in middle-aged patients with atherosclerotic cardiovascular disease (ASCVD), less is understood concerning the role of Lp(a) in oldest-old (≥80 years old) with ASCVD. The aim of the present study was to investigate the relationship between Lp(a) and cardiovascular death (CD) among the oldest-old with acute myocardial infarction (AMI).
A total of 1008 patients with AMI, older than 80 years, were consecutively enrolled between January 2012 and August 2018. The clinical characteristics were collected and Lp(a) concentrations were measured by the immunoturbidimetric method at baseline. The relationship between plasma Lp(a) concentration (≤10 mg/dL, 10-30 mg/dL, >30 mg/dL) and CD was evaluated by Kaplan-Meier analysis and Cox proportional hazard models.
During an average of 36.26 months of follow-up, 287 CD occurred. Data showed that patients with high Lp(a) levels (>30 mg/dL) had the highest rate of CD (p < 0.05). Kaplan-Meier analysis showed that the high Lp(a) group had the lowest event-free survival rate in the oldest-old with AMI (p = 0.030). In addition, subjects with Lp(a) > 30 mg/dL had a 1.5-fold (95% confidence interval: 1.083-2.132) higher risk of CD compared with those with Lp(a) ≤10 mg/dL in fully adjusted Cox proportional hazards model.
The current data firstly showed that plasma Lp(a) concentration was associated with the risk of CD in oldest-old with AMI, suggesting that Lp(a) could be a useful adjunctive measurement in the evaluation of CD in this population.
相较于脂蛋白(a) [Lp(a)] 在中年动脉粥样硬化性心血管疾病 (ASCVD) 患者中的预后价值，人们对其在年龄最大的老年人 (≥80 岁) 与 ASCVD 中的作用知之甚少。本研究旨在探讨急性心肌梗死 (AMI) 中年龄最大的老年人中脂蛋白(a) [Lp(a)] 与心血管死亡 (CD) 的关系。
共纳入 2012 年 1 月至 2018 年 8 月连续就诊的 1008 例年龄超过 80 岁的 AMI 患者。在基线时收集临床特征并采用免疫比浊法测量 Lp(a) 浓度。通过 Kaplan-Meier 分析和 Cox 比例风险模型评估血浆 Lp(a) 浓度 (≤10 mg/dL、10-30 mg/dL、>30 mg/dL) 与 CD 的关系。
在平均 36.26 个月的随访期间，有 287 例患者发生 CD。数据显示，高 Lp(a) 水平 (>30 mg/dL) 患者的 CD 发生率最高 (p<0.05)。Kaplan-Meier 分析显示，在 AMI 年龄最大的老年人中，高 Lp(a) 组的无事件生存率最低 (p=0.030)。此外，在经过充分校正的 Cox 比例风险模型中，Lp(a)>30 mg/dL 的患者发生 CD 的风险是 Lp(a)≤10 mg/dL 的患者的 1.5 倍 (95%置信区间：1.083-2.132)。
本研究首次表明，血浆 Lp(a) 浓度与 AMI 中年龄最大的老年人的 CD 风险相关，提示 Lp(a) 可能是评估该人群 CD 的有用辅助测量指标。
