Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California; Department of Epidemiology, University of California Los Angeles, Los Angeles, California.
Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California; Department of Epidemiology, University of California Los Angeles, Los Angeles, California.
Am J Cardiol. 2021 Apr 15;145:12-17. doi: 10.1016/j.amjcard.2020.12.075. Epub 2021 Jan 14.
The relation between elevated lipoprotein(a) and total atherosclerotic cardiovascular disease (ASCVD) residual risk in persons with known cardiovascular disease on statin therapy is not well-established. We examined first and total recurrent ASCVD event risk in statin-treated adults with prior ASCVD. We studied 3,359 adults (mean age 63.6 years, 85.1% male) with prior ASCVD on statin therapy from the AIM-HIGH clinical trial cohort. The first and total ASCVD event rates were calculated by lipoprotein(a) [Lp(a)] categories. Cox regression and Prentice, Williams and Peterson (PWP) models provided hazard ratios (HRs) for ASCVD events over a mean follow-up of 3.3 years, adjusted for age, gender, trial treatment, LDL-C, and other risk factors. A total of 747 events occurred during follow-up, among which 544 were first events. First and total ASCVD event rates were greater with higher Lp(a) levels. Compared with Lp(a)<15 mg/dL, HRs (95% CIs) for subsequent total ASCVD events among Lp(a) levels of 15-<30, 30-<50, 50-<70, and ≥70 mg/dL were 1.04 (0.82 to 1.32), 1.15 (0.88 to 1.49), 1.27 (1.00 to 1.63) and 1.51 (1.25 to 1.84). Moreover, a continuous relation for total events was observed (HR=1.08 [1.04 to 1.12] per 20 mg/dL greater Lp(a). Findings for first ASCVD events and in those with LDL-C ≥70 mg/dL versus <70 mg/dL and with and without diabetes were similar. The risk of first and total ASCVD events is increased with Lp(a) levels of ≥70 mg/dL and ≥50 mg/dL, respectively, among adults with known CVD on statin therapy.
脂蛋白(a)升高与他汀类药物治疗的已知心血管疾病患者的总动脉粥样硬化性心血管疾病（ASCVD）残余风险之间的关系尚未确定。我们检查了他汀类药物治疗的既往 ASCVD 成人患者的首次和总复发 ASCVD 事件风险。我们研究了来自 AIM-HIGH 临床试验队列的 3359 名他汀类药物治疗的既往 ASCVD 成年患者（平均年龄 63.6 岁，85.1%为男性）。根据脂蛋白(a) [Lp(a)]类别计算首次和总 ASCVD 事件发生率。Cox 回归和 Prentice、Williams 和 Peterson（PWP）模型提供了平均随访 3.3 年后 ASCVD 事件的风险比（HR），调整了年龄、性别、试验治疗、LDL-C 和其他危险因素。随访期间共发生 747 例事件，其中 544 例为首次事件。随着 Lp(a)水平的升高，首次和总 ASCVD 事件发生率更高。与 Lp(a)<15 mg/dL 相比，Lp(a)水平为 15-<30、30-<50、50-<70 和≥70 mg/dL 的患者随后发生总 ASCVD 事件的 HR（95%CI）分别为 1.04（0.82 至 1.32）、1.15（0.88 至 1.49）、1.27（1.00 至 1.63）和 1.51（1.25 至 1.84）。此外，还观察到总事件呈连续关系（HR=1.08 [1.04 至 1.12]，每增加 20 mg/dL 的 Lp(a)）。首次 ASCVD 事件和 LDL-C≥70 mg/dL 与<70 mg/dL 以及有或无糖尿病患者的结果相似。在他汀类药物治疗的已知 CVD 患者中，Lp(a)水平≥70 mg/dL 和≥50 mg/dL 分别与首次和总 ASCVD 事件风险增加相关。
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