Division of Cardiology Massachusetts General Hospital, Harvard Medical School Boston MA.
Baim Institute for Clinical Research Boston MA.
J Am Heart Assoc. 2024 Jun 18;13(12):e034774. doi: 10.1161/JAHA.124.034774. Epub 2024 Jun 11.
Higher lipoprotein(a) and oxidized phospholipid concentrations are associated with increased risk for coronary artery disease and valvular heart disease. The role of lipoprotein(a) or oxidized phospholipid as a risk factor for incident heart failure (HF) or its complications remains uncertain.
A total of 1251 individuals referred for coronary angiography in the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study were stratified on the basis of universal definition of HF stage; those in stage A/B (N=714) were followed up for an average 3.7 years for incident stage C/D HF or the composite of HF/cardiovascular death. During follow-up, 105 (14.7%) study participants in stage A/B progressed to symptomatic HF and 57 (8.0%) had cardiovascular death. In models adjusted for multiple HF risk factors, including severe coronary artery disease and aortic stenosis, individuals with lipoprotein(a) ≥150 nmol/L were at higher risk for progression to symptomatic HF (hazard ratio [HR], 1.90 [95% CI, 1.15-3.13]; =0.01) or the composite of HF/cardiovascular death (HR, 1.71 [95% CI, 1.10-2.67]; =0.02). These results remained significant after further adjustment of the model to include prior myocardial infarction (HF: HR, 1.89, 0.01; HF/cardiovascular death: HR, 1.68, =0.02). Elevated oxidized phospholipid concentrations were similarly associated with risk, particularly when added to higher lipoprotein(a). In Kaplan-Meier analyses, individuals with stage A/B HF and elevated lipoprotein(a) had shorter time to progression to stage C/D HF or HF/cardiovascular death (both log-rank <0.001).
Among individuals with stage A or B HF, higher lipoprotein(a) and oxidized phospholipid concentrations are independent risk factors for progression to symptomatic HF or cardiovascular death.
URL: https://wwwclinicaltrials.gov; Unique identifier: NCT00842868.
脂蛋白(a)和氧化磷脂浓度升高与冠状动脉疾病和心脏瓣膜病的风险增加有关。脂蛋白(a)或氧化磷脂作为心力衰竭（HF）事件或其并发症的风险因素的作用仍不确定。
在心血管疾病导管取样血库（CASABLANCA）研究中，根据 HF 阶段的通用定义，对 1251 名接受冠状动脉造影检查的个体进行分层；A/B 期（N=714）的患者平均随访 3.7 年，以观察 C/D 期 HF 或 HF/心血管死亡的复合终点。随访期间，A/B 期 105 名（14.7%）研究参与者进展为有症状的 HF，57 名（8.0%）发生心血管死亡。在调整了包括严重冠状动脉疾病和主动脉瓣狭窄在内的多个 HF 风险因素的模型中，脂蛋白(a)≥150nmol/L 的个体发生进展为有症状 HF 的风险更高（风险比[HR]，1.90[95%置信区间，1.15-3.13]；=0.01）或 HF/心血管死亡的复合终点（HR，1.71[95%置信区间，1.10-2.67]；=0.02）。在进一步调整模型以纳入既往心肌梗死（HF：HR，1.89，0.01；HF/心血管死亡：HR，1.68，=0.02）后，这些结果仍然具有统计学意义。氧化磷脂浓度升高也与风险相关，尤其是当与较高的脂蛋白(a)结合时。在 Kaplan-Meier 分析中，A/B 期 HF 且脂蛋白(a)升高的个体进展为 C/D 期 HF 或 HF/心血管死亡的时间更短（对数秩检验<0.001）。
在 A 或 B 期 HF 患者中，较高的脂蛋白(a)和氧化磷脂浓度是发生有症状 HF 或心血管死亡的独立危险因素。
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