Agouridis Aris P, Filippatos Theodosios D, Kostapanos Michael, Kostara Christina, Tsimihodimos Vasilis
School of Medicine, European University Cyprus, Nicosia, Cyprus.
Department of Internal Medicine, German Oncology Center, Limassol, Cyprus.
Arch Med Sci Atheroscler Dis. 2024 Feb 19;9:e26-e32. doi: 10.5114/amsad/178441. eCollection 2024.
Lipoprotein(a) [Lp(a)] is a strong, genetically determined, pathogenetic factor of atherosclerotic cardiovascular disease (ASCVD). The aim of this post-hoc analysis was to compare the effect of hypolipidemic treatment on Lp(a) levels of patients with mixed hyperlipidemia.
We previously randomized patients with mixed hyperlipidemia (low-density lipoprotein [LDL-C] > 160 mg/dl and triglycerides > 200 mg/dl) to rosuvastatin monotherapy 40 mg/day (R group, = 30) or rosuvastatin 10 mg/day combined with fenofibrate 200 mg/day (RF group, = 30) or omega-3 fatty acids 2 g/day (RΩ group, = 30). In the present post-hoc analysis, we included only the patients whose Lp(a) levels were assessed (16, 16 and 15 in the R, RF and RΩ groups, respectively). Lipid profile and Lp(a) were measured at baseline and after 3 months of treatment.
Significant reductions in total cholesterol, LDL-C, non-high-density lipoprotein-cholesterol (non-HDL-C) and triglyceride levels were observed in all groups. A significant increase in Lp(a) levels was noted in the R ( = 0.017) and RF ( = 0.029) groups, while no significant difference was seen in the RΩ group ( = NS). Regarding Lp(a) elevations, no differences were found between groups. In the R group, a strong negative correlation between the changes in Lp(a) and LDL-C ( = -0.500, = 0.049) was observed, while a significant negative correlation between the changes in Lp(a) and triglycerides ( = -0.531, = 0.034) was noted in the RF group.
Rosuvastatin and/or fenofibrate treatment increases Lp(a) levels in patients with mixed hyperlipidemia. Novel therapies should target Lp(a) level reduction to decrease the residual ASCVD risk in patients with mixed hyperlipidemia.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的一个重要的、由基因决定的致病因素。本事后分析的目的是比较降脂治疗对混合性高脂血症患者Lp(a)水平的影响。
我们之前将混合性高脂血症患者(低密度脂蛋白[LDL-C]>160mg/dl且甘油三酯>200mg/dl)随机分为瑞舒伐他汀单药治疗组(40mg/天，R组，n = 30)、瑞舒伐他汀10mg/天联合非诺贝特200mg/天治疗组(RF组，n = 30)或ω-3脂肪酸2g/天治疗组(RΩ组，n = 30)。在本次事后分析中，我们仅纳入了Lp(a)水平得到评估的患者(R组、RF组和RΩ组分别为16例、16例和15例)。在基线期和治疗3个月后测量血脂谱和Lp(a)。
所有组的总胆固醇、LDL-C、非高密度脂蛋白胆固醇(non-HDL-C)和甘油三酯水平均显著降低。R组(P = 0.017)和RF组(P = 0.029)的Lp(a)水平显著升高，而RΩ组未见显著差异(P = 无统计学意义)。关于Lp(a)升高，各组之间未发现差异。在R组中，观察到Lp(a)变化与LDL-C之间存在强负相关(P = -0.500，P = 0.049)，而在RF组中，Lp(a)变化与甘油三酯之间存在显著负相关(P = -0.531，P = 0.034)。
瑞舒伐他汀和/或非诺贝特治疗可使混合性高脂血症患者的Lp(a)水平升高。新的治疗方法应以降低Lp(a)水平为目标，以降低混合性高脂血症患者残留的ASCVD风险。
