脂蛋白(a)：心血管风险增加的隐蔽前体？真实世界区域性血脂临床经验。

Lipoprotein(a): A Concealed Precursor of Increased Cardiovascular Risk? A Real-World Regional Lipid Clinic Experience.

机构信息

Department of Internal Medicine, University of Ioannina Medical School, Ioannina, Greece.

出版信息

Arch Med Res. 2021 May;52(4):397-404. doi: 10.1016/j.arcmed.2020.12.003. Epub 2020 Dec 27.

DOI:10.1016/j.arcmed.2020.12.003

PMID:33380360

Abstract

OBJECTIVE

Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor. We present real-life characteristics of patients with increased Lp(a) levels attending a University Lipid Clinic.

METHODS

We retrospectively studied patients attending the University of Ioannina Hospital Lipid Clinic with Lp(a) levels ≥30 mg/dL who were followed-up for a median of 22 months.

RESULTS

One hundred eight patients (median age 59 years, 49% females) were included with median Lp(a) levels 67 mg/dL (30-320). Of patients, 25.1% had established atherosclerotic cardiovascular disease (ASCVD): 11.1 and 5.6% positive personal history of myocardial infarction (MI) and stroke, respectively, 6.5% carotid artery disease and 1.9% lower extremities arterial disease (LEAD). In addition, 35.2% of participants had heterozygous familial hypercholesterolemia (heFH), 37.9% positive family history of premature ASCVD, 29.6% hypertension, 12.0% diabetes and 5.5% chronic kidney disease (CKD). Of patients, 67.6% were receiving statin therapy and 16.6% additional ezetimibe at baseline visit, and 83 and 35% were receiving statin treatment and additional ezetimibe, respectively, during follow-up. Low-density cholesterol (LDL-C) levels and LDL-C levels were significantly reduced in lipid-lowering therapy naive patients by 37 and 40% (p <0.05), in lipid-lowering therapy intensified patients by 31 and 36% (p <0.05), and in patients on stable lipid-lowering treatment by 15% (p <0.05) and 10% (p >0.05), respectively, during follow-up. Lp(a) levels increased by 9% (p <0.05).

CONCLUSION

Our data confirm the high prevalence of established ASCVD, hFH and positive familial history of premature ASCVD in patients with elevated Lp(a) levels. Lp(a) levels slightly increased during follow-up.

摘要

目的

脂蛋白(a)[Lp(a)]是心血管疾病的独立危险因素。本研究旨在介绍在大学脂质诊所就诊的高 Lp(a)水平患者的真实特征。

方法

我们回顾性研究了在约阿尼纳大学医院脂质诊所就诊且 Lp(a)水平≥30mg/dL 的患者，中位随访时间为 22 个月。

结果

共纳入 108 例患者（中位年龄 59 岁，49%为女性），Lp(a)水平中位数为 67mg/dL（范围为 30-320）。25.1%的患者有明确的动脉粥样硬化性心血管疾病（ASCVD）：11.1%和 5.6%分别有心肌梗死（MI）和中风的阳性个人病史，6.5%有颈动脉疾病，1.9%有下肢动脉疾病（LEAD）。此外，35.2%的患者有杂合子家族性高胆固醇血症（heFH），37.9%有 ASCVD 的阳性家族史，29.6%有高血压，12.0%有糖尿病，5.5%有慢性肾脏病（CKD）。患者在基线时有 67.6%接受他汀类药物治疗，16.6%接受依折麦布治疗，在随访期间，分别有 83%和 35%的患者接受他汀类药物和依折麦布治疗。在未接受降脂治疗的患者中，LDL-C 水平和 LDL-C 水平分别降低了 37%和 40%（p<0.05），在强化降脂治疗的患者中，LDL-C 水平和 LDL-C 水平分别降低了 31%和 36%（p<0.05），在接受稳定降脂治疗的患者中，LDL-C 水平和 LDL-C 水平分别降低了 15%和 10%（p<0.05）和 10%（p>0.05），在随访期间，Lp(a)水平增加了 9%（p<0.05）。