Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Department of Medical Sciences, McMaster University, Hamilton, Ontario, Canada.
Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.
J Am Coll Cardiol. 2022 Apr 26;79(16):1579-1590. doi: 10.1016/j.jacc.2022.02.018.
BACKGROUND: Atrial fibrillation (AF) is a cardiac arrhythmia associated with an elevated risk of stroke, heart failure, and mortality. However, preventative therapies are needed with ancillary benefits on its cardiovascular comorbidities. Lipoprotein(a) (Lp[a]) is a recognized risk factor for atherosclerotic cardiovascular disease (ASCVD), which itself increases AF risk, but it remains unknown whether Lp(a) is a causal mediator of AF independent of ASCVD. OBJECTIVES: This study investigated the role of Lp(a) in AF and whether it is independent of ASCVD. METHODS: Measured and genetically predicted Lp(a) levels were tested for association with 20,432 cases of incident AF in the UK Biobank (N = 435,579). Mendelian randomization analyses were performed by using summary-level data for AF from publicly available genome-wide association studies (N = 1,145,375). RESULTS: In the UK Biobank, each 50 nmol/L (23 mg/dL) increase in Lp(a) was associated with an increased risk of incident AF using measured Lp(a) (HR: 1.03; 95% CI: 1.02-1.04 ; P = 1.65 × 10) and genetically predicted Lp(a) (OR: 1.03; 95% CI: 1.02-1.05; P = 1.33 × 10). Mendelian randomization analyses using independent data replicated the effect (OR: 1.04 per 50 nmol/L Lp[a] increase; 95% CI: 1.03-1.05 per 50 nmol/L Lp[a] increase; P = 9.23 × 10). There was no evidence of risk-conferring effect from low-density lipoprotein cholesterol or triglycerides, and only 39% (95% CI: 27%-73%) of Lp(a) risk was mediated through ASCVD, suggesting that Lp(a) partly influences AF independent of its known effects on ASCVD. CONCLUSIONS: Our findings implicate Lp(a) as a potential causal mediator in the development of AF which show that the effects of Lp(a) extend across myocardial tissues. Ongoing clinical trials for Lp(a)-lowering therapies should evaluate effects on AF prevention.
背景:心房颤动(AF)是一种与中风、心力衰竭和死亡率风险增加相关的心律失常。然而,需要预防疗法来治疗其心血管合并症。脂蛋白(a)(Lp[a])是动脉粥样硬化性心血管疾病(ASCVD)的公认危险因素,ASCVD 本身会增加 AF 的风险,但尚不清楚 Lp[a]是否是 ASCVD 之外导致 AF 的因果中介。
目的:本研究旨在探讨 Lp(a)在 AF 中的作用及其是否独立于 ASCVD。
方法:在英国生物库(N=435579)中检测了 20432 例新发 AF 病例的 Lp(a)水平,对 Lp(a)进行了检测和遗传预测。通过使用公开的全基因组关联研究(N=1145375)中获得的 AF 汇总数据,进行了孟德尔随机化分析。
结果:在英国生物库中,Lp(a)每增加 50nmol/L(23mg/dL),使用检测到的 Lp(a)(HR:1.03;95%CI:1.02-1.04;P=1.65×10)和遗传预测的 Lp(a)(OR:1.03;95%CI:1.02-1.05;P=1.33×10),都会增加新发 AF 的风险。使用独立数据进行的孟德尔随机化分析复制了这一效应(OR:Lp[a]每增加 50nmol/L,风险增加 1.04;95%CI:Lp[a]每增加 50nmol/L,风险增加 1.05;P=9.23×10)。LDL 胆固醇或甘油三酯没有显示出风险赋予作用,只有 39%(95%CI:27%-73%)的 Lp(a)风险是通过 ASCVD 介导的,这表明 Lp(a)在一定程度上影响 AF,而不考虑其对 ASCVD 的已知影响。
结论:我们的研究结果表明,Lp(a)可能是 AF 发展的潜在因果中介,这表明 Lp(a)的作用扩展到心肌组织。正在进行的 Lp(a)降低治疗的临床试验应评估对 AF 预防的影响。
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