Department of Cardiology, Campus Benjamin Franklin (CBF), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.
Deutsches Zentrum für Herzkreislaufforschung (DZHK), partner site Berlin, DZHK-Geschäftsstelle, Potsdamer Str. 58, 10785 Berlin, Germany.
Eur J Prev Cardiol. 2024 May 11;31(7):856-865. doi: 10.1093/eurjpc/zwae007.
A thorough characterization of the relationship between elevated lipoprotein(a) [Lp(a)] and coronary artery disease (CAD) is lacking. This study aimed to quantitatively assess the association of increasing Lp(a) levels and CAD severity in a real-world population.
This non-interventional, cross-sectional, LipidCardio study included patients aged ≥21 years undergoing angiography (October 2016-March 2018) at a tertiary cardiology centre, who have at least one Lp(a) measurement. The association between Lp(a) and CAD severity was determined by synergy between PCI with taxus and cardiac surgery (SYNTAX)-I and Gensini scores and angiographic characteristics. Overall, 975 patients (mean age: 69.5 years) were included; 70.1% were male, 97.5% had Caucasian ancestry, and 33.2% had a family history of premature atherosclerotic cardiovascular disease. Median baseline Lp(a) level was 19.3 nmol/L. Patients were stratified by baseline Lp(a): 72.9% had < 65 nmol/L, 21.0% had ≥100 nmol/L, 17.2% had ≥125 nmol/L, and 12.9% had ≥150 nmol/L. Compared with the normal (Lp(a) < 65 nmol/L) group, elevated Lp(a) groups (e.g. ≥ 150 nmol/L) had a higher proportion of patients with prior CAD (48.4% vs. 62.7%; P < 0.01), prior coronary revascularization (39.1% vs. 51.6%; P = 0.01), prior coronary artery bypass graft (6.0% vs. 15.1%; P < 0.01), vessel(s) with lesions (68.5% vs. 81.3%; P = 0.03), diffusely narrowed vessels (10.9% vs. 16.5%; P = 0.01) or chronic total occlusion lesions (14.3% vs. 25.2%; P < 0.01), and higher median SYNTAX-I (3.0 vs. 5.5; P = 0.01) and Gensini (10.0 vs. 16.0; P < 0.01) scores.
Elevated Lp(a) was associated with a more severe presentation of CAD. Awareness of Lp(a) levels in patients with CAD may have implications in their clinical management.
脂蛋白(a) [Lp(a)] 升高与冠状动脉疾病 (CAD) 之间的关系尚未得到充分描述。本研究旨在定量评估真实人群中 Lp(a) 水平升高与 CAD 严重程度的相关性。
这项非介入性、横断面的 LipidCardio 研究纳入了 2016 年 10 月至 2018 年 3 月在一家三级心脏病中心接受血管造影检查（年龄≥21 岁的患者），并至少有一次 Lp(a) 检测。Lp(a) 与 CAD 严重程度的相关性通过经皮冠状动脉介入治疗与紫杉醇联合心脏手术 (SYNTAX)-I 和 Gensini 评分以及血管造影特征来确定。共有 975 例患者（平均年龄：69.5 岁）入选；70.1%为男性，97.5%为白种人，33.2%有早发性动脉粥样硬化性心血管疾病家族史。基线 Lp(a) 水平中位数为 19.3 nmol/L。患者按基线 Lp(a) 分层：72.9%的患者 < 65 nmol/L，21.0%的患者≥100 nmol/L，17.2%的患者≥125 nmol/L，12.9%的患者≥150 nmol/L。与正常（Lp(a) < 65 nmol/L）组相比，升高的 Lp(a) 组（如≥150 nmol/L）有更高比例的既往 CAD（48.4% vs. 62.7%；P < 0.01）、既往冠状动脉血运重建（39.1% vs. 51.6%；P = 0.01）、既往冠状动脉旁路移植术（6.0% vs. 15.1%；P < 0.01）、有病变的血管（68.5% vs. 81.3%；P = 0.03）、弥漫性狭窄血管（10.9% vs. 16.5%；P = 0.01）或慢性完全闭塞病变（14.3% vs. 25.2%；P < 0.01），且 SYNTAX-I（3.0 与 5.5；P = 0.01）和 Gensini（10.0 与 16.0；P < 0.01）评分中位数更高。
升高的 Lp(a) 与 CAD 更严重的表现有关。了解 CAD 患者的 Lp(a) 水平可能对其临床管理具有重要意义。
