脂蛋白(a)水平对 LDL 胆固醇或载脂蛋白 B 相关冠心病风险的影响。

Impact of Lipoprotein(a) Level on Low-Density Lipoprotein Cholesterol- or Apolipoprotein B-Related Risk of Coronary Heart Disease.

机构信息

Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

J Am Coll Cardiol. 2024 Jul 9;84(2):165-177. doi: 10.1016/j.jacc.2024.04.050.

DOI:10.1016/j.jacc.2024.04.050

PMID:38960510

Abstract

BACKGROUND

Conventional low-density lipoprotein cholesterol (LDL-C) quantification includes cholesterol attributable to lipoprotein(a) (Lp(a)-C) due to their overlapping densities.

OBJECTIVES

The purposes of this study were to compare the association between LDL-C and LDL-C corrected for Lp(a)-C (LDL) with incident coronary heart disease (CHD) in the general population and to investigate whether concomitant Lp(a) values influence the association of LDL-C or apolipoprotein B (apoB) with coronary events.

METHODS

Among 68,748 CHD-free subjects at baseline LDL was calculated as "LDL-C-Lp(a)-C," where Lp(a)-C was 30% or 17.3% of total Lp(a) mass. Fine and Gray competing risk-adjusted models were applied for the association between the outcome incident CHD and: 1) LDL-C and LDL in the total sample; and 2) LDL-C and apoB after stratification by Lp(a) mass (≥/<90th percentile).

RESULTS

Similar risk estimates for incident CHD were found for LDL-C and LDL-C or LDL-C (subdistribution HR with 95% CI) were 2.73 (95% CI: 2.34-3.20) vs 2.51 (95% CI: 2.15-2.93) vs 2.64 (95% CI: 2.26-3.10), respectively (top vs bottom fifth; fully adjusted models). Categorization by Lp(a) mass resulted in higher subdistribution HRs for uncorrected LDL-C and incident CHD at Lp(a) ≥90th percentile (4.38 [95% CI: 2.08-9.22]) vs 2.60 [95% CI: 2.21-3.07]) at Lp(a) <90th percentile (top vs bottom fifth; P0.39). In contrast, apoB risk estimates were lower in subjects with higher Lp(a) mass (2.43 [95% CI: 1.34-4.40]) than in Lp(a) <90th percentile (3.34 [95% CI: 2.78-4.01]) (P0.49).

CONCLUSIONS

Correction of LDL-C for its Lp(a)-C content provided no meaningful information on CHD-risk estimation at the population level. Simple categorization of Lp(a) mass (≥/<90th percentile) influenced the association between LDL-C or apoB with future CHD mostly at higher Lp(a) levels.

摘要

背景

传统的低密度脂蛋白胆固醇（LDL-C）定量包括由于重叠密度而归因于脂蛋白（a）（Lp(a)-C）的胆固醇。

目的

本研究的目的是比较人群中 LDL-C 和校正 Lp(a)-C（LDL）的 LDL-C 与冠心病（CHD）事件的相关性，并探讨同时存在的 Lp(a) 值是否影响 LDL-C 或载脂蛋白 B（apoB）与冠状动脉事件的相关性。

方法

在基线时，无 CHD 的 68748 例受试者中，LDL 计算为“LDL-C-Lp(a)-C”，其中 Lp(a)-C 占总 Lp(a) 质量的 30%或 17.3%。采用 Fine 和 Gray 竞争风险调整模型，分析以下结果与事件性 CHD 的相关性：1）总样本中 LDL-C 和 LDL；2）按 Lp(a)质量（≥/<90 百分位）分层后 LDL-C 和 apoB。

结果

LDL-C 和 LDL-C 或 LDL-C（亚分布风险比，95%置信区间）的 CHD 事件风险估计值相似，分别为 2.73（95%CI：2.34-3.20）、2.51（95%CI：2.15-2.93）和 2.64（95%CI：2.26-3.10）（最高 vs 最低五分位数；完全调整模型）。按 Lp(a)质量分类，在 Lp(a)≥90 百分位时，未经校正的 LDL-C 和 CHD 事件的亚分布风险比更高（4.38 [95%CI：2.08-9.22]），而在 Lp(a)<90 百分位时（2.60 [95%CI：2.21-3.07]）（最高 vs 最低五分位数；P0.39）。相比之下，在 Lp(a)较高的受试者中，apoB 的风险估计值较低（2.43 [95%CI：1.34-4.40]），而在 Lp(a)<90 百分位时（3.34 [95%CI：2.78-4.01]）（P0.49）。