Girard Arnaud, Gaillard Emilie, Puri Rishi, Capoulade Romain, Chan Kwan L, Paulin Audrey, Manikpurage Hasanga D, Dumesnil Jean, Tam James W, Teo Koon K, Couture Christian, Wareham Nicholas J, Clavel Marie-Annick, Stroes Erik S G, Mathieu Patrick, Thériault Sébastien, Tsimikas Sotirios, Pibarot Philippe, Boekholdt S Matthijs, Arsenault Benoit J
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, G1V 4G5, Canada.
Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, 1105 AZ, The Netherlands.
Eur Heart J Open. 2023 Mar 30;3(2):oead032. doi: 10.1093/ehjopen/oead032. eCollection 2023 Mar.
AIMS: Elevated lipoprotein(a) [Lp(a)] levels are associated with the risk of coronary artery disease (CAD) and calcific aortic valve stenosis (CAVS). Observational studies revealed that Lp(a) and C-reactive protein (CRP) levels, a biomarker of systemic inflammation, may jointly predict CAD risk. Whether Lp(a) and CRP levels also jointly predict CAVS incidence and progression is unknown. METHODS AND RESULTS: We investigated the association of Lp(a) with CAVS according to CRP levels in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study ( = 18 226, 406 incident cases) and the UK Biobank ( = 438 260, 4582 incident cases), as well as in the ASTRONOMER study ( = 220), which assessed the haemodynamic progression rate of pre-existing mild-to-moderate aortic stenosis. In EPIC-Norfolk, in comparison to individuals with low Lp(a) levels (<50 mg/dL) and low CRP levels (<2.0 mg/L), those with elevated Lp(a) (>50 mg/dL) and low CRP levels (<2.0 mg/L) and those with elevated Lp(a) (>50 mg/dL) and elevated CRP levels (>2.0 mg/L) had a higher CAVS risk [hazard ratio (HR) = 1.86 (95% confidence intervals, 1.30-2.67) and 2.08 (1.44-2.99), respectively]. A comparable predictive value of Lp(a) in patients with vs. without elevated CRP levels was also noted in the UK Biobank. In ASTRONOMER, CAVS progression was comparable in patients with elevated Lp(a) levels with or without elevated CRP levels. CONCLUSION: Lp(a) predicts the incidence and possibly progression of CAVS regardless of plasma CRP levels. Lowering Lp(a) levels may warrant further investigation in the prevention and treatment of CAVS, regardless of systemic inflammation.
目的:脂蛋白(a)[Lp(a)]水平升高与冠状动脉疾病(CAD)及钙化性主动脉瓣狭窄(CAVS)风险相关。观察性研究显示,Lp(a)与全身炎症生物标志物C反应蛋白(CRP)水平可能共同预测CAD风险。Lp(a)和CRP水平是否也共同预测CAVS的发生率和进展尚不清楚。 方法与结果:我们在欧洲癌症与营养前瞻性调查(EPIC)-诺福克研究(n = 18226,406例发病病例)和英国生物银行(n = 438260,4582例发病病例)中,以及在评估已存在的轻至中度主动脉瓣狭窄血流动力学进展率的ASTRONOMER研究(n = 220)中,根据CRP水平研究Lp(a)与CAVS的关联。在EPIC-诺福克研究中,与Lp(a)水平低(<50mg/dL)且CRP水平低(<2.0mg/L)的个体相比,Lp(a)升高(>50mg/dL)且CRP水平低(<2.0mg/L)以及Lp(a)升高(>50mg/dL)且CRP水平升高(>2.0mg/L)的个体发生CAVS的风险更高[风险比(HR)分别为1.86(95%置信区间,1.30 - 2.67)和2.08(1.44 - 2.99)]。在英国生物银行中也观察到,Lp(a)在CRP水平升高和未升高的患者中具有相似的预测价值。在ASTRONOMER研究中,Lp(a)水平升高且CRP水平升高或未升高的患者,CAVS进展情况相当。 结论:无论血浆CRP水平如何,Lp(a)均可预测CAVS的发生率及可能的进展情况。降低Lp(a)水平在CAVS的预防和治疗中是否可行值得进一步研究,无论是否存在全身炎症。
Eur Heart J Open. 2023-3-30
Circ Cardiovasc Imaging. 2022-1
J Am Coll Cardiol. 2020-12-22