School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Australia.
School of Clinical Medicine, St Vincent's Hospital, Sydney, Australia.
Curr Med Res Opin. 2023 Jul;39(7):933-938. doi: 10.1080/03007995.2023.2214434. Epub 2023 Jun 12.
OBJECTIVE: Elevated Lipoprotein(a) [Lp(a)] has not been firmly established as a risk factor for recurrent coronary heart disease (CHD). The present analysis explored this relationship in senior citizens. METHODS: This was a longitudinal study in 607 subjects, all with prevalent CHD, mean age 71 years, followed for 16 years. Baseline examinations of lipids and other CHD risk factors were conducted in 1988-89 in Dubbo, Australia. The independent contribution of Lp(a) to a further CHD event was examined in proportional hazards regression models. RESULTS: There were 399 incident CHD cases. Median Lp(a) in CHD cases was 130 mg/L (Interquartile range 60-315) and in non-cases 105 mg/L (45-250) ( < .07, U-Test). 26% of CHD cases and 19% of non-cases had Lp(a) 300 + mg/L; 18% of CHD cases and 8% of non-cases had Lp(a) 500 + mg/L. Lp(a) in Quintile 5 of its distribution (355 + mg/L), using Lp(a) Quintile 1 (<50mg/L) as reference, significantly predicted recurrent CHD with Hazard Ratio 1.53 (95% CI 1.11-2.11, = .01). Prediction was independent of other risk factors. Lp(a) 500 + mg/L versus lower, significantly predicted recurrent CHD with Hazard Ratio 1.59 (1.16-2.17, < .01). Prediction was similarly significant for Lp(a) 300 + mg/L versus lower, with Hazard Ratio 1.37 (1.09-1.73, < .01). CONCLUSION: Elevated Lp(a) is an independent and significant predictor of recurrent CHD in senior citizens. Upper reference Lp(a) levels of 500 mg/L (≈125nmol/L) or 300 mg/L (≈75nmol/L) both appear to be appropriate. The clinical benefit of therapy to reduce elevated Lp(a) remains to be confirmed.
目的：脂蛋白（a）[Lp(a)]升高是否为复发性冠心病（CHD）的危险因素尚未确定。本分析探讨了在老年人中的这种关系。
方法：这是一项在 607 名患有明确 CHD 的受试者中进行的纵向研究，平均年龄为 71 岁，随访时间为 16 年。基线血脂和其他 CHD 危险因素检查于 1988-89 年在澳大利亚的杜博进行。采用比例风险回归模型检查 Lp(a)对进一步 CHD 事件的独立贡献。
结果：发生 399 例 CHD 事件。CHD 病例的中位 Lp(a)为 130mg/L（四分位距 60-315），非病例为 105mg/L（45-250）（ < .07，U 检验）。26%的 CHD 病例和 19%的非病例的 Lp(a)为 300 + mg/L；18%的 CHD 病例和 8%的非病例的 Lp(a)为 500 + mg/L。使用 Lp(a)第 1 四分位数（<50mg/L）作为参考，分布第 5 四分位数（355 + mg/L）的 Lp(a)显著预测复发性 CHD，风险比为 1.53（95%CI 1.11-2.11， = .01）。预测独立于其他危险因素。Lp(a) 500 + mg/L 与更低水平相比，显著预测复发性 CHD，风险比为 1.59（1.16-2.17， < .01）。Lp(a) 300 + mg/L 与更低水平相比，预测复发性 CHD 的风险比为 1.37（1.09-1.73， < .01），结果也具有显著意义。
结论：在老年人中，升高的 Lp(a)是复发性 CHD 的独立且重要的预测因子。500mg/L（≈125nmol/L）或 300mg/L（≈75nmol/L）的上限参考 Lp(a)水平似乎都是合适的。降低升高的 Lp(a)的治疗的临床获益仍有待证实。
Curr Med Res Opin. 2023-7
Arterioscler Thromb Vasc Biol. 2013-10-3
Zotero 插件