Afanasieva Olga I, Tyurina Alexandra V, Klesareva Elena A, Arefieva Tatiana I, Ezhov Marat V, Pokrovsky Sergei N
Institute of Experimental Cardiology, National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
J Pers Med. 2022 Feb 12;12(2):269. doi: 10.3390/jpm12020269.
The detection of lipoprotein(a) [Lp(a)] in the artery wall at the stage of lipid-bands formation may indicate that it participates in the atherosclerosis local nonspecific inflammatory process. Innate immune cells are involved in atherogenesis, with monocytes playing a major role in the initiation of atherosclerosis, while neutrophils can contribute to plaque destabilization. This work studies the relationship between Lp(a), immune blood cells and major adverse cardiovascular events (MACE) in patients with the early manifestation of coronary heart disease (CHD). The study included 200 patients with chronic CHD, manifested up to the age of 55 in men and 60 in women. An increased Lp(a) concentration [hyperLp(a)] was shown to predict cardiovascular events in patients with premature CHD with long-term follow-up. According to the logistic regression analysis results, an increase in the monocyte count with OR = 4.58 (95% CI 1.04-20.06) or lymphocyte-to-monocyte ratio with OR = 0.82 (0.68-0.99), ( < 0.05 for both) was associated with MACE in patients with early CHD, regardless of gender, age, classical risk factors, atherogenic lipoproteins concentration and statin intake. The combination of an increased monocyte count and hyperLp(a) significantly increased the proportion of patients with early CHD with subsequent development of MACE ( = 0.02, = 0.003). The odds of cardiovascular events in patients with early CHD manifestation were highest in patients with an elevated lymphocyte-to-monocyte ratio and an elevated Lp(a) level. A higher neutrophil blood count and an elevated neutrophil-to-lymphocyte ratio determined the faster development of MACE in patients with a high Lp(a) concentration. The data obtained in this study suggest that the high atherothrombogenicity of Lp(a) is associated with the "inflammatory" component and the innate immune cells involvement in this process. Thus, the easily calculated immunological ratios of blood cells and Lp(a) concentrations can be considered simple predictors of future cardiovascular events.
在脂质条纹形成阶段检测动脉壁中的脂蛋白(a)[Lp(a)]可能表明它参与了动脉粥样硬化的局部非特异性炎症过程。固有免疫细胞参与动脉粥样硬化的发生，单核细胞在动脉粥样硬化的起始中起主要作用，而中性粒细胞可导致斑块不稳定。这项工作研究了冠心病(CHD)早期表现患者中Lp(a)、免疫血细胞与主要不良心血管事件(MACE)之间的关系。该研究纳入了200例慢性CHD患者，男性发病年龄最高为55岁，女性为60岁。长期随访显示，Lp(a)浓度升高[高Lp(a)]可预测早发CHD患者的心血管事件。根据逻辑回归分析结果，单核细胞计数增加（OR = 4.58，95%CI 1.04 - 20.06）或淋巴细胞与单核细胞比值增加（OR = 0.82，0.68 - 0.99）（两者均P < 0.05）与早发CHD患者的MACE相关，与性别、年龄、经典危险因素、致动脉粥样硬化脂蛋白浓度和他汀类药物摄入无关。单核细胞计数增加和高Lp(a)的组合显著增加了早发CHD患者随后发生MACE的比例（P = 0.02，P = 0.003）。早发CHD表现患者中，淋巴细胞与单核细胞比值升高且Lp(a)水平升高的患者发生心血管事件的几率最高。较高的中性粒细胞计数和中性粒细胞与淋巴细胞比值升高决定了高Lp(a)浓度患者中MACE的更快发展。本研究获得的数据表明，Lp(a)的高动脉血栓形成性与“炎症”成分以及固有免疫细胞参与这一过程有关。因此，易于计算的血细胞免疫比值和Lp(a)浓度可被视为未来心血管事件的简单预测指标。
