Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.
Atherosclerosis. 2023 Sep;381:117217. doi: 10.1016/j.atherosclerosis.2023.117217. Epub 2023 Aug 9.
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but is not included in the Pooled Cohort Equations (PCE). We aimed to assess how well the PCE predict 10-year event rates in individuals with elevated Lp(a), and whether the addition of Lp(a) improves risk prediction.
We compared observed versus PCE-predicted 10-year ASCVD event rates, stratified by Lp(a) level and ASCVD risk category using Poisson regression, and evaluated the association between Lp(a) > 50 mg/dL and ASCVD risk using Cox proportional hazards models in the Multi-Ethnic Study of Atherosclerosis (MESA). We evaluated the C-index and net reclassification improvement (NRI) with addition of Lp(a) to the PCE.
The study population included 6639 individuals (20%, n = 1325 with elevated Lp(a)). The PCE accurately predicted 10-year event rates for individuals with elevated Lp(a) with observed event rates falling within predicted limits. Elevated Lp(a) was associated with increased risk of CVD events overall (HR 1.27, 95% CI 1.00-1.60), particularly in low (HR 2.45, 95% CI 1.40-4.31), and high-risk (HR 1.41, 95% CI 1.02-1.96) individuals. Continuous NRI (95% CI) with the addition of Lp(a) to the PCE for CVD was 0.0963 (0.0158-0.1953) overall, and 0.2999 (0.0876, 0.5525) among low-risk individuals.
The PCE performs well for event rate prediction in individuals with elevated Lp(a). However, Lp(a) is associated with increased CVD risk, and the addition of Lp(a) to the PCE improves risk prediction, particularly among low-risk individuals. These results lend support for increasing use of Lp(a) testing for risk assessment.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病（ASCVD）的独立危险因素，但未包含在聚集队列方程（PCE）中。我们旨在评估 PCE 对 Lp(a)升高个体 10 年事件发生率的预测效果，以及添加 Lp(a)是否能改善风险预测。
我们使用泊松回归比较了按 Lp(a)水平和 ASCVD 风险类别分层的观察到的与 PCE 预测的 10 年 ASCVD 事件发生率，并使用多民族动脉粥样硬化研究（MESA）中的 Cox 比例风险模型评估了 Lp(a)>50mg/dL 与 ASCVD 风险之间的关系。我们使用 PCE 中添加 Lp(a)的 C 指数和净重新分类改善（NRI）进行评估。
研究人群包括 6639 名个体（20%，n=1325 名 Lp(a)升高）。PCE 准确地预测了 Lp(a)升高个体的 10 年事件发生率，观察到的事件发生率落在预测范围内。Lp(a)升高与 CVD 事件风险增加相关（HR 1.27，95%CI 1.00-1.60），尤其是在低危（HR 2.45，95%CI 1.40-4.31）和高危（HR 1.41，95%CI 1.02-1.96）个体中。将 Lp(a)添加到 PCE 后，CVD 的连续 NRI（95%CI）为 0.0963（0.0158-0.1953），在低危个体中为 0.2999（0.0876，0.5525）。
PCE 对 Lp(a)升高个体的事件发生率预测效果良好。然而，Lp(a)与 CVD 风险增加相关，将 Lp(a)添加到 PCE 中可改善风险预测，尤其是在低危个体中。这些结果为增加 Lp(a)检测用于风险评估提供了支持。
