Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2023 May 9;81(18):1780-1792. doi: 10.1016/j.jacc.2023.02.050.
BACKGROUND: Lipoprotein(a) (Lp[a]) and oxidized phospholipids (OxPLs) are each independent risk factors for atherosclerotic cardiovascular disease. The extent to which Lp(a) and OxPLs predict coronary artery disease (CAD) severity and outcomes in a contemporary, statin-treated cohort is not well established. OBJECTIVES: This study sought to evaluate the relationships between Lp(a) particle concentration and OxPLs associated with apolipoprotein B (OxPL-apoB) or apolipoprotein(a) (OxPL-apo[a]) with angiographic CAD and cardiovascular outcomes. METHODS: Among 1,098 participants referred for coronary angiography in the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) study, Lp(a), OxPL-apoB, and OxPL-apo(a) were measured. Logistic regression estimated the risk of multivessel coronary stenoses by Lp(a)-related biomarker level. Cox proportional hazards regression estimated the risk of major adverse cardiovascular events (MACEs) (coronary revascularization, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) in follow-up. RESULTS: Median Lp(a) was 26.45 nmol/L (IQR: 11.39-89.49 nmol/L). Lp(a), OxPL-apoB, and OxPL-apo(a) were highly correlated (Spearman R ≥0.91 for all pairwise combinations). Lp(a) and OxPL-apoB were associated with multivessel CAD. Odds of multivessel CAD per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.10 (95% CI: 1.03-1.18; P = 0.006), 1.18 (95% CI: 1.03-1.34; P = 0.01), and 1.07 (95% CI: 0.99-1.16; P = 0.07), respectively. All biomarkers were associated with cardiovascular events. HRs for MACE per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.08 (95% CI: 1.03-1.14; P = 0.001), 1.15 (95% CI: 1.05-1.26; P = 0.004), and 1.07 (95% CI: 1.01-1.14; P = 0.02), respectively. CONCLUSIONS: In patients undergoing coronary angiography, Lp(a) and OxPL-apoB are associated with multivessel CAD. Lp(a), OxPL-apoB, and OxPL-apo(a) are associated with incident cardiovascular events. (Catheter Sampled Blood Archive in Cardiovascular Diseases [CASABLANCA]; NCT00842868).
背景：脂蛋白(a)[Lp(a)]和氧化型磷脂（OxPLs）都是动脉粥样硬化性心血管疾病的独立危险因素。Lp(a)和 OxPLs 在他汀类药物治疗的当代队列中预测冠状动脉疾病（CAD）严重程度和结局的程度尚不清楚。 目的：本研究旨在评估 Lp(a)颗粒浓度与载脂蛋白 B 相关的 OxPLs（OxPL-apoB）或载脂蛋白(a)相关的 OxPLs（OxPL-apo[a]）与血管造影 CAD 和心血管结局之间的关系。 方法：在 CASABLANCA（心血管疾病中导管采样血库）研究中，对 1098 名接受冠状动脉造影的患者进行了 Lp(a)、OxPL-apoB 和 OxPL-apo[a]的测量。逻辑回归估计了 Lp(a)相关生物标志物水平与多血管 CAD 之间的风险。Cox 比例风险回归估计了随访中主要不良心血管事件（MACEs）（冠状动脉血运重建、非致命性心肌梗死、非致命性卒中和心血管死亡）的风险。 结果：Lp(a)的中位数为 26.45 nmol/L（IQR：11.39-89.49 nmol/L）。Lp(a)、OxPL-apoB 和 OxPL-apo[a]高度相关（Spearman R≥0.91，所有两两组合）。Lp(a)和 OxPL-apoB 与多血管 CAD 相关。Lp(a)、OxPL-apoB 和 OxPL-apo[a]每增加一倍，多血管 CAD 的几率分别为 1.10（95%CI：1.03-1.18；P=0.006）、1.18（95%CI：1.03-1.34；P=0.01）和 1.07（95%CI：0.99-1.16；P=0.07）。所有生物标志物均与心血管事件相关。Lp(a)、OxPL-apoB 和 OxPL-apo[a]每增加一倍的 MACE 风险比分别为 1.08（95%CI：1.03-1.14；P=0.001）、1.15（95%CI：1.05-1.26；P=0.004）和 1.07（95%CI：1.01-1.14；P=0.02）。 结论：在接受冠状动脉造影的患者中，Lp(a)和 OxPL-apoB 与多血管 CAD 相关。Lp(a)、OxPL-apoB 和 OxPL-apo[a]与心血管事件的发生有关。（心血管疾病中导管采样血库[CASABLANCA]；NCT00842868）。
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