Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China.
Front Endocrinol (Lausanne). 2024 May 15;15:1392859. doi: 10.3389/fendo.2024.1392859. eCollection 2024.
OBJECTIVE: Although lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (Hs-CRP) are closely associated with the mortality of acute myocardial infarction (AMI), their synergistic effect on the risk of death remains unknown. Therefore, this study aimed to explore the combined effect of Lp(a) and Hs-CRP on the incidence of all-cause and cardiovascular death in AMI patients. METHODS: A comprehensive cohort study enrolled 912 AMI patients, categorizing them into four groups based on Lp(a) and Hs-CRP levels: Group 1 [Lp(a) < 30 mg/dL & Hs-CRP < 2 mg/L], Group 2 [Lp(a) < 30 mg/dL & Hs-CRP ≥ 2 mg/L], Group 3 [Lp(a) ≥ 30 mg/dL & Hs-CRP < 2 mg/L], and Group 4 [Lp(a) ≥ 30 mg/dL & Hs-CRP ≥ 2 mg/L]. Cox regression analysis, Kaplan-Meier survival analysis and sensitivity analysis were employed to determine the combined effects of Lp(a) and Hs-CRP on the risk of all-cause and cardiovascular death. RESULTS: Over a median observation period of 38.98 months, 217 patients passed away, with 137 deaths attributed to cardiovascular causes. The multivariate Cox regression analysis revealed that in the comprehensively adjusted Model 3, only Lp(a) and the combination of Lp(a) and Hs-CRP exhibited a strong association with cardiovascular death risk. Specifically, for Lp(a) levels ≥ 30 mg/dL compared to < 30 mg/dL, the hazard ratio (HR) was 2.434 with a 95% confidence interval (CI) of 1.653-3.583 (P < 0.001); for log(Lp(a)), the HR was 2.630 with a 95% CI of 1.530-4.523 (P < 0.001); for Group 4 versus Group 1, the HR was 2.346 with a 95% CI of 1.054-5.220 (P = 0.037); and for Group 4 versus Groups 1 + 2 + 3, the HR was 1.878 with a 95% CI of 1.284-2.748 (P = 0.001). Sensitivity analysis indicated that the synergy between Lp(a) and Hs-CRP continued to be independently associated with the risk of cardiovascular death. For Group 3 versus Group 1, the HR was 3.353 with a 95% CI of 1.133-9.917 (P = 0.029); for Group 4 versus Group 1, the HR was 3.710 with a 95% CI of 1.466-9.392 (P = 0.006); and for Group 4 versus Groups 1 + 2 + 3, the HR was 2.433 with a 95% CI of 1.620-3.656 (P < 0.001). CONCLUSIONS: Compared to elevated levels of either Lp(a) or Hs-CRP alone, the concurrent high levels of both significantly increased the risk of cardiovascular death in patients with AMI, underscoring the importance of considering their combined effects in the prognostic management of AMI patients.
目的：脂蛋白(a) [Lp(a)]和高敏 C 反应蛋白 (Hs-CRP)与急性心肌梗死 (AMI)的死亡率密切相关，但它们对死亡风险的协同作用尚不清楚。因此，本研究旨在探讨 Lp(a)和 Hs-CRP 联合对 AMI 患者全因和心血管死亡风险的影响。
方法：一项综合队列研究纳入了 912 例 AMI 患者，根据 Lp(a)和 Hs-CRP 水平将其分为 4 组：组 1 [Lp(a) < 30 mg/dL & Hs-CRP < 2 mg/L]、组 2 [Lp(a) < 30 mg/dL & Hs-CRP ≥ 2 mg/L]、组 3 [Lp(a) ≥ 30 mg/dL & Hs-CRP < 2 mg/L]和组 4 [Lp(a) ≥ 30 mg/dL & Hs-CRP ≥ 2 mg/L]。采用 Cox 回归分析、Kaplan-Meier 生存分析和敏感性分析来确定 Lp(a)和 Hs-CRP 联合对全因和心血管死亡风险的影响。
结果：在中位观察期 38.98 个月内，217 例患者死亡，其中 137 例死于心血管原因。多变量 Cox 回归分析显示，在全面调整的模型 3 中，只有 Lp(a)和 Lp(a)与 Hs-CRP 的联合与心血管死亡风险具有强烈相关性。具体而言，与 < 30 mg/dL 相比，Lp(a)水平≥30 mg/dL 的风险比 (HR)为 2.434，95%置信区间 (CI) 为 1.653-3.583 (P < 0.001)；对于 log(Lp(a))，HR 为 2.630，95%CI 为 1.530-4.523 (P < 0.001)；与组 4 相比，组 1 的 HR 为 2.346，95%CI 为 1.054-5.220 (P = 0.037)；与组 1 + 2 + 3 相比，组 4 的 HR 为 1.878，95%CI 为 1.284-2.748 (P = 0.001)。敏感性分析表明，Lp(a)和 Hs-CRP 之间的协同作用与心血管死亡风险仍具有独立相关性。与组 3 相比，组 1 的 HR 为 3.353，95%CI 为 1.133-9.917 (P = 0.029)；与组 4 相比，组 1 的 HR 为 3.710，95%CI 为 1.466-9.392 (P = 0.006)；与组 1 + 2 + 3 相比，组 4 的 HR 为 2.433，95%CI 为 1.620-3.656 (P < 0.001)。
结论：与单独升高 Lp(a)或 Hs-CRP 相比，同时升高两者水平显著增加了 AMI 患者的心血管死亡风险，这强调了在 AMI 患者的预后管理中考虑其联合作用的重要性。
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