Department of Cardiology, University of Oldenburg, 26133 Oldenburg, Germany.
Institute for Hypertension and Cardiovascular Research (INFO), St.-Josefs-Hospital, 49661 Cloppenburg, Germany.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1569-1575. doi: 10.31083/j.rcm2204162.
Lipoprotein(a) (Lp(a)) is becoming increasingly important as an independent risk factor for cardiovascular disease. Since no effective therapy currently exists other than lipid apheresis, the recommendation remains to optimally adjust all other cardiovascular risk factors (CVRF). In a Northwest German population study, the frequency of elevated Lp(a) levels and all other CVRF was investigated. The aim was to investigate whether individuals with elevated Lp(a) levels were also more likely to have other CVRFs. To date, 4602 individuals have been enrolled in the study, and blood pressure, weight, lipids, diabetes, medications, and pre-existing conditions were recorded in addition to Lp(a). In addition, questionnaires assessed physical activity, psychological stress, depression, and brain dysfunction. All participants received detailed individual recommendation about their CVRF and its treatment. In the further follow-up of 5 years, it will be examined how persons with elevated Lp(a) implemented these recommendations in comparison with participants without elevated Lp(a). The first group Lp(a) <75 nmol/L consisted of 3550 (80.2%), the Lp(a) 75-120 nmol/L group of 341 (7.4%) and the Lp(a) >120 nmol/L of 538 (11.7%). 81.6% of all participants had one or more CVRF. Age, sex, and prevalence of hypertension, diabetes, smoking, obesity, and exercise did not differ among the 3 groups. As expected, LDL-Cholesterol was significantly elevated in the Lp(a) >120 nmol/L group despite significantly more frequent use of statins. Significantly more often hypertensive patients were found in the Lp(a) >120 nmol/L group who were inadequately controlled by medication and significantly less often persons without further CVRF. No differences existed in the frequency of psychological stress, depression, and mild cognitive impairment. CVRF occur with comparable frequency in individuals with elevated Lp(a) levels. However, individuals with Lp(a) above 120 nmol/L were more likely to have poorly controlled blood pressure, elevated LDL-C, and less likely to have no other risk factors. This underlines that in case of Lp(a) elevation all further CVRF should be intensively adjusted, especially in case of strongly elevated values >120 nmol/L. However, these recommendations have not been adequately implemented in clinical care in this population to date.
脂蛋白(a)（Lp(a)）作为心血管疾病的独立危险因素变得越来越重要。由于除了血脂吸附外目前没有有效的治疗方法，因此仍然建议优化调整所有其他心血管危险因素（CVRF）。在一项德国西北部人群研究中，调查了升高的 Lp(a)水平和所有其他 CVRF 的频率。目的是研究升高 Lp(a)水平的个体是否也更有可能存在其他 CVRF。迄今为止，已有 4602 人参加了该研究，除了 Lp(a)外，还记录了血压、体重、血脂、糖尿病、药物和既往疾病。此外，问卷调查了身体活动、心理压力、抑郁和大脑功能障碍。所有参与者都收到了关于其 CVRF 及其治疗的详细个人建议。在接下来的 5 年随访中，将检查与未升高 Lp(a)的参与者相比，升高 Lp(a)的人如何实施这些建议。Lp(a) <75 nmol/L 的第一组有 3550 人（80.2%），Lp(a) 75-120 nmol/L 组有 341 人（7.4%），Lp(a) >120 nmol/L 组有 538 人（11.7%）。所有参与者中有 81.6%有一个或多个 CVRF。三组之间的年龄、性别、高血压、糖尿病、吸烟、肥胖和运动的患病率没有差异。正如预期的那样，尽管他汀类药物的使用频率明显更高，但 Lp(a) >120 nmol/L 组的 LDL-Cholesterol 明显升高。在药物治疗下血压控制不佳的高血压患者明显更多，而没有其他 CVRF 的患者明显更少。在心理压力、抑郁和轻度认知障碍的频率方面没有差异。升高的 Lp(a)水平的个体中存在类似频率的 CVRF。然而，Lp(a)水平高于 120 nmol/L 的个体更有可能血压控制不佳，LDL-C 升高，而没有其他危险因素的可能性较低。这强调了在 Lp(a)升高的情况下，应密切调整所有其他 CVRF，尤其是在值升高>120 nmol/L 的情况下。然而，迄今为止，这些建议在该人群的临床护理中尚未得到充分实施。
