Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
JACC Cardiovasc Interv. 2022 Jul 25;15(14):1466-1476. doi: 10.1016/j.jcin.2022.05.050.
Elevated lipoprotein(a) (Lp[a]) levels are an independent risk factor for the development of atherosclerotic diseases, including peripheral artery disease (PAD). However, their prognostic impact in patients with PAD remains unknown.
The aim of this study was to examine the prognostic impact of elevated Lp(a) levels in patients with PAD undergoing endovascular therapy (EVT).
In total, 1,169 patients who underwent successful EVT for symptomatic PAD between September 2016 and August 2021 were included in this study. High Lp(a) levels were defined as >30 mg/dL. The associations of high Lp(a) levels with incident major adverse cardiovascular events (MACE) (all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE) (repeat revascularization for target limb and major amputation) were analyzed.
During a median follow-up period of 1.7 years (IQR: 0.6-3.0 years), 230 MACE (210 deaths, 15 myocardial infarctions, and 22 strokes) and 263 MALE (219 reinterventions and 36 major amputations) were observed. The cumulative incidence rate of MACE (48.1% vs 27.3%) and MALE (67.9% vs 27.2%) was significantly higher in patients with high Lp(a) levels (P < 0.001 for both). The adjusted HR were 1.93 (95% CI: 1.44-2.59; P < 0.001) for MACE and 4.15 (95% CI: 3.14-5.50; P < 0.001) for MALE. These associations were not influenced by low-density lipoprotein cholesterol levels or statin administration (P for interaction >0.05 for all).
Elevated Lp(a) levels were independently associated with incident MACE and MALE in patients with PAD treated with revascularization irrespective of low-density lipoprotein cholesterol level and statin administration.
脂蛋白(a)（Lp[a]）水平升高是动脉粥样硬化性疾病（包括外周动脉疾病[PAD]）发展的独立危险因素。然而，其在 PAD 患者中的预后影响尚不清楚。
本研究旨在探讨接受血管内治疗（EVT）的 PAD 患者中升高的 Lp(a)水平的预后影响。
本研究共纳入 1169 例 2016 年 9 月至 2021 年 8 月期间因有症状 PAD 接受成功 EVT 的患者。高 Lp(a)水平定义为>30mg/dL。分析高 Lp(a)水平与主要不良心血管事件（MACE）（全因死亡、心肌梗死和卒中）和主要不良肢体事件（MALE）（靶肢体再次血运重建和主要截肢）的发生之间的相关性。
在中位随访 1.7 年（IQR：0.6-3.0 年）期间，观察到 230 例 MACE（210 例死亡、15 例心肌梗死和 22 例卒中）和 263 例 MALE（219 例再介入和 36 例主要截肢）。高 Lp(a)水平患者的 MACE（48.1%比 27.3%）和 MALE（67.9%比 27.2%）累积发生率显著更高（均 P<0.001）。调整后的 HR 分别为 MACE 的 1.93（95%CI：1.44-2.59；P<0.001）和 MALE 的 4.15（95%CI：3.14-5.50；P<0.001）。这些相关性不受低密度脂蛋白胆固醇水平或他汀类药物治疗的影响（所有交互 P 值均>0.05）。
无论低密度脂蛋白胆固醇水平和他汀类药物治疗情况如何，升高的 Lp(a)水平与接受血运重建治疗的 PAD 患者的 MACE 和 MALE 事件独立相关。
