State Key Laboratory of Cardiovascular Disease, Beijing, China.
Cardiometabolic Medicine Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A Beilishi Road, Xi Cheng District, Beijing, 100037, China.
J Endocrinol Invest. 2024 Apr;47(4):883-894. doi: 10.1007/s40618-023-02203-3. Epub 2023 Sep 30.
Elevated lipoprotein(a) [Lp(a)] and diabetes mellitus (DM) are both associated with adverse events in high-risk patients with established coronary artery disease (CAD). Currently, the association between Lp(a) levels and recurrent cardiovascular (CV) events (CVEs) remained undetermined in patients with different glucose status. Therefore, this study aimed to investigate the prognostic significance of Lp(a) levels for recurrent CVEs in high-risk CAD patients who suffered from first CVEs according to different glycemic metabolism.
We recruited 5257 consecutive patients with prior CVEs and followed up for recurrent CVEs, including CV death, non-fatal myocardial infarction (MI), and non-fatal stroke. Patients were assigned to low, medium, and high groups according to Lp(a) levels and further stratified by glucose status.
During a median 37-month follow-up, 225 (4.28%) recurrent CVEs occurred. High Lp(a) was independently associated with recurrent CVEs [adjusted Hazard Ratio (HR), 1.57; 95% confidence interval (CI) 1.12-2.19; P = 0.008]. When participants were classified according to Lp(a) levels and glycemic status, high Lp(a) levels were associated with an increased risk of recurrent CVEs in pre-DM (adjusted HR, 2.96; 95% CI 1.24-7.05; P = 0.014). Meanwhile, medium and high Lp(a) levels were both associated with an increased risk for recurrent CVEs in DM (adjusted HR, 3.09; 95% CI 1.30-7.34; P = 0.010 and adjusted HR, 3.13, 95% CI 1.30-7.53; P = 0.011, respectively).
This study demonstrated that elevated Lp(a) levels were associated with an increased recurrent CVE risk in patients with CAD, particularly among those with pre-DM and DM, indicating that Lp(a) may provide incremental value in risk stratification in this population.
脂蛋白(a) [Lp(a)]升高和糖尿病（DM）均与已确诊冠心病（CAD）的高危患者的不良事件相关。目前，Lp(a)水平与不同血糖状态患者的复发性心血管事件（CVE）之间的关系仍未确定。因此，本研究旨在根据不同的糖代谢情况，探讨 Lp(a)水平对首次发生 CVE 的高危 CAD 患者复发性 CVE 的预后意义。
我们招募了 5257 例连续发生过 CVE 且有复发性 CVE（包括心血管死亡、非致死性心肌梗死和非致死性卒中等）随访记录的患者。根据 Lp(a)水平将患者分为低、中、高组，并根据血糖状态进一步分层。
在中位 37 个月的随访期间，发生了 225 例（4.28%）复发性 CVE。高 Lp(a)水平与复发性 CVE 独立相关（调整后的危险比[HR]，1.57；95%置信区间[CI]，1.12-2.19；P=0.008）。当根据 Lp(a)水平和血糖状态对参与者进行分类时，高 Lp(a)水平与 pre-DM 患者发生复发性 CVE 的风险增加相关（调整后的 HR，2.96；95%CI，1.24-7.05；P=0.014）。同时，中、高水平的 Lp(a)与 DM 患者发生复发性 CVE 的风险增加相关（调整后的 HR，3.09；95%CI，1.30-7.34；P=0.010 和调整后的 HR，3.13；95%CI，1.30-7.53；P=0.011）。
本研究表明，Lp(a)水平升高与 CAD 患者的复发性 CVE 风险增加相关，特别是在 pre-DM 和 DM 患者中，提示 Lp(a)可能为该人群的风险分层提供额外的价值。
