Division of Cardiology, University of California-Irvine, Irvine, California, USA; Department of Epidemiology and Biostatistics, University of California-Irvine, Irvine, California, USA.
Division of Cardiology, University of California-Irvine, Irvine, California, USA; Department of Epidemiology and Biostatistics, University of California-Irvine, Irvine, California, USA.
J Am Coll Cardiol. 2024 Apr 23;83(16):1511-1525. doi: 10.1016/j.jacc.2024.02.031.
Lipoprotein(a) (Lp[a]) is a causal genetic risk factor for atherosclerotic cardiovascular disease (ASCVD). There are limited long-term follow-up data from large U.S. population cohorts.
This study examined the relationship of Lp(a) with ASCVD outcomes in a large, pooled, multi-ethnic U.S.
The study included data on Lp(a) and ASCVD outcomes from 5 U.S.
MESA (Multi-Ethnic Study of Atherosclerosis), CARDIA (Coronary Artery Risk Development in Young Adults), JHS (Jackson Heart Study), FHS-OS (Framingham Heart Study-Offspring), and ARIC (Atherosclerosis Risk In Communities). Lp(a) levels were classified on the basis of cohort-specific percentiles. Multivariable Cox regression related Lp(a) with composite incident ASCVD events by risk group and diabetes status.
The study included 27,756 persons without previous ASCVD who were aged 20 to 79 years, including 55.0% women, 35.6% Black participants, and 7.6% patients with diabetes, with mean follow-up of 21.1 years. Compared with Lp(a) levels <50th percentile, Lp(a) levels in the 50th to <75th, 75th to <90th, and ≥90th percentiles had adjusted HRs of 1.06 (95% CI: 0.99-1.14), 1.18 (95% CI: 1.09-1.28), and 1.46 (95% CI: 1.33-1.59), respectively for ASCVD events. Elevated Lp(a) predicted incident ASCVD events similarly by risk group, sex, and race or ethnic groups, but more strongly in patients with vs without diabetes (interaction P = 0.0056), with HRs for Lp(a) levels ≥90th percentile of 1.92 (95% CI: 1.50-2.45) and 1.41 (95% CI: 1.28-1.55), respectively. Lp(a) also individually predicted myocardial infarction, revascularization, stroke, and coronary heart disease death, but not total mortality.
The study shows, in a large U.S. pooled cohort, that higher Lp(a) levels are associated with an increased ASCVD risk, including in patients with diabetes.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病（ASCVD）的一个因果遗传风险因素。目前，美国大型人群队列的长期随访数据有限。
本研究旨在一个大型的、多族裔的美国人群队列中，研究脂蛋白(a)与 ASCVD 结局之间的关系。
这项研究纳入了来自 5 项美国前瞻性研究的数据：多民族动脉粥样硬化研究（MESA）、冠状动脉风险发展（青年）研究（CARDIA）、杰克逊心脏研究（JHS）、弗雷明汉心脏研究后代队列（FHS-OS）和社区动脉粥样硬化风险研究（ARIC）。根据队列特异性百分位数对 Lp(a)水平进行分类。多变量 Cox 回归分析将 Lp(a)与复合首发 ASCVD 事件相关，并按风险组和糖尿病状态进行分层。
这项研究纳入了 27756 名无 ASCVD 病史、年龄在 20 至 79 岁之间的患者，其中 55.0%为女性，35.6%为黑人参与者，7.6%为糖尿病患者，平均随访时间为 21.1 年。与 Lp(a)水平低于第 50 百分位相比，第 50 至第 75 百分位、第 75 至第 90 百分位和第 90 百分位以上的 Lp(a)水平的校正 HR 分别为 1.06（95%CI：0.99-1.14）、1.18（95%CI：1.09-1.28）和 1.46（95%CI：1.33-1.59），分别用于 ASCVD 事件。Lp(a)水平升高同样预示着 ASCVD 事件的发生，且与风险组、性别和种族或民族有关，但在有糖尿病和无糖尿病的患者中，其预测作用更强（交互 P=0.0056），Lp(a)水平处于第 90 百分位以上的患者发生 ASCVD 的 HR 分别为 1.92（95%CI：1.50-2.45）和 1.41（95%CI：1.28-1.55）。Lp(a)还可以单独预测心肌梗死、血运重建、卒中和冠心病死亡，但不能预测全因死亡率。
这项研究表明，在一个大型的美国人群队列中，较高的 Lp(a)水平与 ASCVD 风险增加相关，包括在有糖尿病的患者中。
