Cardiometabolic Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research, Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research, Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
J Atheroscler Thromb. 2024 Sep 1;31(9):1319-1332. doi: 10.5551/jat.64693. Epub 2024 Apr 13.
No data are currently available regarding the association between Lp(a) and the cardiovascular outcomes in patients with coronary artery disease (CAD) according to their family history (FHx) of CAD. This study aimed to evaluate the significance of Lp(a) in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) with or without FHx.
A total of 6056 patients with CCS were enrolled. Information on FHx was collected, and the plasma Lp(a) levels were measured. All patients were followed up regularly. The independent and joint associations of Lp(a) and FHx with the risk of MACEs, including cardiovascular death, nonfatal myocardial infarction, and stroke, were analyzed.
With over an average of 50.35±18.58 months follow-up, 378 MACEs were recorded. A Cox regression analysis showed an elevated Lp(a) level to be an independent predictor for MACEs in patients with [hazard ratio (HR): 2.77, 95% confidence interval (CI): 1.38-5.54] or without FHx (HR: 1.35, 95% CI: 1.02-1.77). In comparison to subjects with non-elevated Lp(a) and negative FHx, patients with elevated Lp(a) alone were at a nominally higher risk of MACEs (HR: 1.26, 95% CI: 0.96-1.67), while those with both had the highest risk (HR: 1.93, 95% CI: 1.14-3.28). Moreover, adding Lp(a) to the original model increased the C-statistic by 0.048 in subjects with FHx (p=0.004) and by 0.004 in those without FHx (p=0.391).
The present study is the first to suggest that Lp(a) could be used to predict MACEs in CCS patients with or without FHx; however, its prognostic significance was more noteworthy in patients with FHx.
目前尚无数据显示脂蛋白(a)（Lp(a)）与冠心病（CAD）家族史（FHx）患者的心血管结局之间存在关联。本研究旨在评估 Lp(a)在预测伴有或不伴有 FHx 的慢性冠脉综合征（CCS）患者主要不良心血管事件（MACEs）中的意义。
共纳入 6056 例 CCS 患者。收集 FHx 信息，并测量血浆 Lp(a)水平。所有患者均定期随访。分析 Lp(a)和 FHx 与 MACEs（包括心血管死亡、非致死性心肌梗死和卒中）风险的独立和联合关联。
平均随访 50.35±18.58 个月后，共记录到 378 例 MACEs。Cox 回归分析显示，Lp(a)水平升高是伴有 FHx（风险比[HR]：2.77，95%置信区间[CI]：1.38-5.54）或不伴有 FHx（HR：1.35，95%CI：1.02-1.77）患者发生 MACEs 的独立预测因素。与非升高 Lp(a)和阴性 FHx 的患者相比，仅升高 Lp(a)的患者发生 MACEs的风险略有升高（HR：1.26，95%CI：0.96-1.67），而同时升高 Lp(a)和 FHx 的患者风险最高（HR：1.93，95%CI：1.14-3.28）。此外，在伴有 FHx 的患者中，将 Lp(a)加入原始模型后，C 统计量增加了 0.048（p=0.004），在不伴有 FHx 的患者中增加了 0.004（p=0.391）。
本研究首次提示，Lp(a)可用于预测伴有或不伴有 FHx 的 CCS 患者的 MACEs；然而，其预后意义在伴有 FHx 的患者中更为显著。
