Liu Jin, Liu Liwei, Wang Bo, Chen Shiqun, Liu Buyun, Liang Jingjing, Huang Haozhang, Li Qiang, Lun Zhubin, Ying Ming, Chen Guanzhong, Huang Zhidong, Xu Danyuan, Yan Xiaoming, Zhu Tingting, Tadesse Girmaw Abebe, Tan Ning, Chen Jiyan, Liu Yong
Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States.
Front Cardiovasc Med. 2021 Aug 31;8:670859. doi: 10.3389/fcvm.2021.670859. eCollection 2021.
A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (≥15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients. We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (<15 and ≥15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (≥15 mg/dL) and long-term all-cause mortality. During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations <15 mg/dL, lipoprotein(a) ≥15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04-1.16, -values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases. Moderately elevated baseline plasma lipoprotein(a) levels (≥15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even <15 mg/dL) in CAD outcome trials.
脂蛋白(a)水平升高会导致心血管事件或死亡风险增加。然而，中度升高的脂蛋白(a)水平（≥15mg/dL）与冠状动脉疾病（CAD）患者长期预后之间的关联仍不明确。因此，我们旨在系统分析一大群CAD患者基线血浆脂蛋白(a)水平与长期死亡率的相关性。我们获取了2007年1月至2018年12月期间43647例被诊断为CAD且有随访信息患者的数据。这些患者被分为两组（<15mg/dL和≥15mg/dL）。主要终点是长期全因死亡。采用Kaplan-Meier曲线分析和Cox比例风险模型来研究中度升高的基线脂蛋白(a)水平（≥15mg/dL）与长期全因死亡率之间的关联。在中位随访5.04年期间，3941例（18.1%）患者死亡。我们观察到脂蛋白(a)水平与长期全因死亡率之间存在线性关联。与脂蛋白(a)浓度<15mg/dL相比，脂蛋白(a)≥15mg/dL与全因死亡率显著更高的风险相关[调整后风险比（aHR）1.10，95%CI：1.04-1.16，P值=0.001]。在非急性心肌梗死、非经皮冠状动脉介入治疗、慢性心力衰竭、糖尿病或非慢性肾脏疾病的亚组分析中也发现了类似结果。CAD患者基线血浆脂蛋白(a)水平中度升高（≥15mg/dL）与全因死亡率显著升高相关。我们的发现为在CAD结局试验中以更低目标（甚至<15mg/dL）检验降低脂蛋白(a)假说提供了理论依据。
