脂蛋白（a）、高敏C反应蛋白与接受经皮冠状动脉介入治疗患者的心血管风险
Lipoprotein(a), high-sensitivity C-reactive protein, and cardiovascular risk in patients undergoing percutaneous coronary intervention.
作者信息
Yuan Deshan, Wang Peizhi, Jia Sida, Zhang Ce, Zhu Pei, Jiang Lin, Liu Ru, Xu Jingjing, Tang Xiaofang, Song Ying, Yao Yi, Xu Na, Zhang Yin, Zhao Xueyan, Yang Yuejin, Xu Bo, Gao Lijian, Gao Zhan, Gao Runlin, Yuan Jinqing
机构信息
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, PR China.
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, PR China.
出版信息
Atherosclerosis. 2022 Dec;363:109-116. doi: 10.1016/j.atherosclerosis.2022.10.013. Epub 2022 Oct 25.
BACKGROUND AND AIMS
In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), the effects of high-sensitivity C-reactive protein (hsCRP) on Lipoprotein(a) (Lp(a))-associated cardiovascular risk remains unclear. This study aimed to investigate the independent and combined association of Lp(a) and hsCRP with cardiovascular events in this specific population.
METHODS
A total of 10,424 patients with measurements of both Lp(a) and hsCRP were included in this prospective cohort study. Cox proportional hazards models and Kaplan-Meier analysis were performed to evaluate the relationship between Lp(a), hsCRP and adverse cardiac and cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischemic stroke and revascularization).
RESULTS
During 5 years of follow-up, 2140 (20.5%) MACCE occurred. Elevated Lp(a) and hsCRP levels were associated with increased risks of MACCE (p<0.05). Notably, there might be a significant interaction between Lp(a) and hsCRP (P for interaction = 0.019). In the setting of hsCRP≥2 mg/L, significant higher risk of MACCE was observed with Lp(a) 15-29.9 mg/dL (HR: 1.18; 95% CI 1.01-1.39) and Lp(a) ≥30 mg/dL (HR: 1.20; 95% CI 1.04-1.39), whereas such association was attenuated when hsCRP was <2 mg/L with Lp(a) 15-29.9 mg/dL (HR: 0.94; 95% CI 0.80-1.10) and Lp(a) ≥30 mg/dL (HR: 1.12; 95% CI 0.98-1.28). Moreover, when Lp(a) and hsCRP were combined for risk stratification, patients with dual elevation of these two biomarkers had a significant higher risk of MACCE compared with the reference group (Lp(a) < 15 mg/dL and hsCRp<2 mg/L) (p<0.05).
CONCLUSIONS
In patients with CAD undergoing PCI, high Lp(a) level was associated with worse outcomes, and this association might be stronger in those with elevated hsCRP concomitantly. Evaluation of Lp(a) and hsCRP together may help identify high-risk individuals for targeted intervention in clinical utility.
背景与目的
在接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者中，高敏C反应蛋白（hsCRP）对脂蛋白（a）[Lp（a）]相关心血管风险的影响尚不清楚。本研究旨在探讨在这一特定人群中，Lp（a）和hsCRP与心血管事件的独立及联合关联。
方法
本前瞻性队列研究共纳入10424例同时检测了Lp（a）和hsCRP的患者。采用Cox比例风险模型和Kaplan-Meier分析来评估Lp（a）、hsCRP与不良心脑血管事件（主要不良心脑血管事件；全因死亡、心肌梗死、缺血性卒中和血运重建）之间的关系。
结果
在5年的随访期间，发生了2140例（20.5%）主要不良心脑血管事件。Lp（a）和hsCRP水平升高与主要不良心脑血管事件风险增加相关（p<0.05）。值得注意的是，Lp（a）和hsCRP之间可能存在显著的相互作用（交互作用P=0.019）。在hsCRP≥2mg/L的情况下，Lp（a）为15 - 29.9mg/dL（HR：1.18；95%CI 1.01 - 1.39）和Lp（a）≥30mg/dL（HR：1.20；95%CI 1.04 - 1.39）时，主要不良心脑血管事件风险显著更高，而当hsCRP<2mg/L时，Lp（a）为15 - 29.9mg/dL（HR：0.94；95%CI 0.80 - 1.10）和Lp（a）≥30mg/dL（HR：1.12；95%CI 0.98 - 1.28）时，这种关联减弱。此外，当将Lp（a）和hsCRP联合进行风险分层时，与参照组（Lp（a）<15mg/dL且hsCRP<2mg/L）相比，这两种生物标志物双升的患者发生主要不良心脑血管事件的风险显著更高（p<0.05）。
结论
在接受PCI的CAD患者中，高Lp（a）水平与更差的预后相关，并且在hsCRP也升高的患者中这种关联可能更强。同时评估Lp（a）和hsCRP可能有助于在临床应用中识别高危个体以进行靶向干预。
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