Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M.).
Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX (M.C.-A., J.V.-E., S.L., S.G.A.-K., K.N.).
Circ Cardiovasc Imaging. 2024 Jul;17(7):e016152. doi: 10.1161/CIRCIMAGING.123.016152. Epub 2024 Jul 16.
Elevated levels of lipoprotein(a) (Lp(a)) are independently associated with an increased risk of atherosclerotic cardiovascular disease events. However, the mechanisms driving this association are poorly understood. We aimed to evaluate the association between Lp(a) and coronary plaque characteristics in a contemporary US cohort without clinical atherosclerotic cardiovascular disease, undergoing coronary computed tomography angiography, the noninvasive gold standard for the assessment of coronary atherosclerosis.
We used baseline data from the Miami Heart Study-a community-based, prospective cohort study-which included asymptomatic adults aged 40 to 65 years evaluated using coronary computed tomography angiography. Those taking any lipid-lowering therapies were excluded. Elevated Lp(a) was defined as ≥125 nmol/L. Outcomes included any plaque, coronary artery calcium score >0, maximal stenosis ≥50%, presence of any high-risk plaque feature (positive remodeling, spotty calcification, low-attenuation plaque, napkin ring), and the presence of ≥2 high-risk plaque features.
Among 1795 participants (median age, 52 years; 54.3% women; 49.6% Hispanic), 291 (16.2%) had Lp(a) ≥125 nmol/L. In unadjusted analyses, individuals with Lp(a) ≥125 nmol/L had a higher prevalence of all outcomes compared with Lp(a) <125 nmol/L, although differences were only statistically significant for the presence of any coronary plaque and ≥2 high-risk features. In multivariable models, elevated Lp(a) was independently associated with the presence of any coronary plaque (odds ratio, 1.40, [95% CI, 1.05-1.86]) and with ≥2 high-risk features (odds ratio, 3.94, [95% CI, 1.82-8.52]), although only 35 participants had this finding. Among participants with a coronary artery calcium score of 0 (n=1200), those with Lp(a) ≥125 nmol/L had a significantly higher percentage of any plaque compared with those with Lp(a) <125 nmol/L (24.2% versus 14.2%; <0.001).
In this contemporary analysis, elevated Lp(a) was independently associated with the presence of coronary plaque. Larger studies are needed to confirm the strong association observed with the presence of multiple high-risk coronary plaque features.
脂蛋白(a)（Lp(a)）水平升高与动脉粥样硬化性心血管疾病事件的风险增加独立相关。然而，驱动这种关联的机制仍知之甚少。我们旨在评估在未患有临床动脉粥样硬化性心血管疾病的当代美国队列中，脂蛋白(a)与冠状动脉斑块特征之间的关联，该队列接受了冠状动脉计算机断层扫描血管造影术，这是评估冠状动脉粥样硬化的非侵入性金标准。
我们使用了迈阿密心脏研究（Miami Heart Study）的基线数据，这是一项基于社区的前瞻性队列研究，纳入了接受冠状动脉计算机断层扫描血管造影术评估的年龄在 40 至 65 岁之间的无症状成年人。排除了正在服用任何降脂药物的患者。脂蛋白(a)升高定义为≥125 nmol/L。研究结果包括任何斑块、冠状动脉钙评分>0、最大狭窄程度≥50%、存在任何高危斑块特征（正性重构、点状钙化、低衰减斑块、餐巾环）和存在≥2 个高危斑块特征。
在 1795 名参与者（中位年龄 52 岁；54.3%为女性；49.6%为西班牙裔）中，有 291 名（16.2%）脂蛋白(a)≥125 nmol/L。在未经调整的分析中，脂蛋白(a)≥125 nmol/L 的个体与脂蛋白(a)<125 nmol/L 的个体相比，所有结局的发生率均较高，尽管仅在存在任何冠状动脉斑块和≥2 个高危特征方面存在统计学差异。在多变量模型中，脂蛋白(a)升高与存在任何冠状动脉斑块（优势比，1.40；95%置信区间，1.05-1.86）和≥2 个高危特征（优势比，3.94；95%置信区间，1.82-8.52）独立相关，尽管只有 35 名参与者存在这种情况。在冠状动脉钙评分为 0 的参与者中（n=1200），脂蛋白(a)≥125 nmol/L 的个体与脂蛋白(a)<125 nmol/L 的个体相比，任何斑块的发生率明显更高（24.2%比 14.2%；<0.001）。
在本项当代分析中，脂蛋白(a)升高与冠状动脉斑块的存在独立相关。需要更大规模的研究来证实与存在多个高危冠状动脉斑块特征的强烈关联。
