与非2型糖尿病患者相比，脂蛋白(a)是2型糖尿病患者冠状动脉疾病更高的残余风险因素。
Lipoprotein(a) as a Higher Residual Risk for Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus than without.
作者信息
Yu Bingyan, Hu Xiangming, Liu Jieliang, Nie Zhiqiang, Ren Luo Bu Ci, Li Guang, Zhou Yingling, Dong Haojian
机构信息
School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
出版信息
Int J Gen Med. 2023 Aug 8;16:3383-3391. doi: 10.2147/IJGM.S423458. eCollection 2023.
PURPOSE
Lipoprotein(a) (Lp[a]) is well-known as a residual risk factor for coronary artery disease (CAD). However, the different adverse effects of Lp(a) about CAD in patients with or without type 2 diabetes mellitus (T2DM) are unclear. This study aimed to investigate the Lp(a) thresholds for CAD diagnosis in T2DM and non-T2DM patients, and further compare the Lp(a) alarm values along with optimal low-density lipoprotein cholesterol (LDL-C) level.
METHODS
This retrospective study consecutively enrolled patients with suspected CAD who underwent coronary angiography in Guangdong Provincial People's Hospital between September 2014 and July 2015. A logistic regression model was established to explore the association of Lp(a) and CAD in patients. Restricted cubic splines were used to compare the threshold values of Lp(a) for CAD in patients with and without T2DM, and further in optimal LDL-C level situation.
RESULTS
There were 1522 patients enrolled finally. After multivariable adjustment, Lp(a) was an independent risk factor for CAD in patients with T2DM (odds ratio [OR]: 1.98, 95% CI]: 1.12-3.49, p = 0.019) and without T2DM (OR: 3.42, 95% CI: 2.36-4.95, p < 0.001). In the whole population, the Lp(a) threshold of CAD was 155, while 145 mg/L for T2DM and 162 mg/L for non-T2DM ones, respectively. In patients with LDL-C<1.8 mmol/l, the alarm value of Lp(a) was even lower in T2DM than non-T2DM patients (155 vs 174 mg/L).
CONCLUSION
Lp(a) was a significant residual risk for CAD in patients whether with T2DM or not. And Lp(a) had a lower alarm value in T2DM patients, especially in optimal LDL-C level.
目的
脂蛋白(a) [Lp(a)] 是冠状动脉疾病（CAD）的一个众所周知的残余风险因素。然而，Lp(a) 对合并或不合并2型糖尿病（T2DM）的CAD患者的不同不良影响尚不清楚。本研究旨在探讨T2DM和非T2DM患者CAD诊断的Lp(a) 阈值，并进一步比较Lp(a) 警报值与最佳低密度脂蛋白胆固醇（LDL-C）水平。
方法
本回顾性研究连续纳入了2014年9月至2015年7月在广东省人民医院接受冠状动脉造影的疑似CAD患者。建立逻辑回归模型以探讨患者中Lp(a) 与CAD的关联。使用受限立方样条比较合并和不合并T2DM患者以及处于最佳LDL-C水平情况下CAD的Lp(a) 阈值。
结果
最终纳入1522例患者。多变量调整后，Lp(a) 是合并T2DM患者（比值比[OR]：1.98，95%置信区间[CI]：1.12 - 3.49，p = 0.019）和不合并T2DM患者（OR：3.42，95% CI：2.36 - 4.95，p < 0.001）CAD的独立危险因素。在总体人群中，CAD的Lp(a) 阈值为155，而T2DM患者为145 mg/L，非T2DM患者为162 mg/L。在LDL-C < 1.8 mmol/l的患者中，T2DM患者的Lp(a) 警报值甚至低于非T2DM患者（155 vs 174 mg/L）。
结论
无论是否合并T2DM，Lp(a) 都是CAD患者的显著残余风险因素。并且Lp(a) 在T2DM患者中的警报值较低，尤其是在最佳LDL-C水平时。
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