Department of Cardiology, Ningbo Municipal Medical Center LiHuili Hospital, Zhejiang, China.
Department of Cardiology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, China.
BMC Cardiovasc Disord. 2022 Nov 8;22(1):474. doi: 10.1186/s12872-022-02932-y.
Lipoprotein (a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). Recent studies have indicated that statins tend to increase Lp(a) levels by 10-20%. However, the association of statin-mediated increases in Lp(a) levels with CAD has not been determined. METHODS: This study included 488 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Lp(a) levels were measured at baseline and 1 month after statin therapy. The study endpoints were major adverse cardiovascular events (MACE). Hazard ratios for the MACE were adjusted for potential confounder using Cox regression.
After statin therapy, the mean level of Lp(a) increased by 19.3% from baseline. Lp(a) levels increased in 307 patients (62.9%) with a median elevation of 4.1 mg/dL. Patients with an increase in Lp(a) were at higher risk for MACE than those without an increase in Lp(a) (p = 0.044). Subgroup analyses revealed that a mild-to-moderate increase in Lp(a) was not associated with MACE, whereas there was a strong correlation between the highest quartile increase in Lp(a) (≥ 10.1 mg/dL) and MACE (HR = 2.29, 95%CI = 1.36-3.84, p = 0.002). This correlation was independent of baseline Lp(a) levels but not independent of on-statin Lp(a) levels.
Severe increases in Lp(a) following statin therapy raise the risk of MACE, but a mild-to-moderate increase in Lp(a) may not affect the cardiovascular prognosis of CAD patients. Even if the baseline Lp(a) levels are low, it is necessary to continue testing for Lp(a) concentration at least once after statin.
脂蛋白(a)[Lp(a)]是冠心病（CAD）的独立危险因素。最近的研究表明，他汀类药物往往会使 Lp(a)水平升高 10-20%。然而，他汀类药物引起的 Lp(a)水平升高与 CAD 的相关性尚未确定。
本研究纳入了 488 例接受经皮冠状动脉介入治疗（PCI）的急性冠脉综合征（ACS）患者。在他汀类药物治疗前和治疗后 1 个月测量 Lp(a)水平。研究终点为主要不良心血管事件（MACE）。使用 Cox 回归调整潜在混杂因素后，MACE 的风险比。
他汀类药物治疗后，Lp(a)水平从基线平均升高 19.3%。307 例（62.9%）患者的 Lp(a)水平升高，中位数升高 4.1mg/dL。与 Lp(a)水平未升高的患者相比，Lp(a)水平升高的患者发生 MACE 的风险更高（p=0.044）。亚组分析显示，Lp(a)轻度至中度升高与 MACE 无关，而 Lp(a)升高最高四分位数（≥10.1mg/dL）与 MACE 之间存在强烈相关性（HR=2.29，95%CI=1.36-3.84，p=0.002）。这种相关性独立于基线 Lp(a)水平，但不独立于他汀类药物治疗后的 Lp(a)水平。
他汀类药物治疗后 Lp(a)水平的严重升高会增加 MACE 的风险，但 Lp(a)的轻度至中度升高可能不会影响 CAD 患者的心血管预后。即使基线 Lp(a)水平较低，也有必要在他汀类药物治疗后至少再次检测 Lp(a)浓度。
