Zhang Biyang, Xu Yinxiao, Huang Xin, Sun Tienan, Ma Meishi, Chen Zheng, Zhou Yujie
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2024 Sep 5;11:1466146. doi: 10.3389/fcvm.2024.1466146. eCollection 2024.
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, the association between Lp(a) and adverse outcomes in patients with ischemic heart failure (IHF) remains unclear. This study aimed to investigate the relationship between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.
In this single-center, retrospective cohort study, 1,168 IHF patients who underwent elective percutaneous coronary intervention (PCI) were enrolled. Patients were divided into four groups based on Lp(a) quartiles. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. Cox proportional hazards models were used to evaluate the association between Lp(a) quartiles and adverse outcomes. Restricted cubic spline (RCS) curve were constructed to explore the nonlinear relationship between Lp(a) levels and MACE risk. Subgroup analyses were performed to investigate the association in different subgroups.
The incidence of MACE increased significantly across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, < 0.001). After adjusting for confounding factors, the highest Lp(a) group remained independently associated with an increased risk of MACE (HR, 95% CI: 2.28, 1.69-3.07, < 0.001, P for trend <0.001), all-cause mortality (HR, 95% CI: 2.33, 1.54-3.54, < 0.001, P for trend = 0.01), and any revascularization (HR, 95% CI: 2.18, 1.35-3.53, = 0.002, P for trend = 0.001). The RCS model demonstrated a nonlinear positive relationship between Lp(a) levels and MACE risk. Subgroup analysis revealed a significant interaction with body mass index (BMI), with a more pronounced association observed in patients with higher BMI (P for interaction <0.001).
Elevated Lp(a) levels were independently associated with an increased risk of MACE, mortality, and revascularization in IHF patients, with a stronger effect in obese individuals.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的独立危险因素。然而，Lp(a)与缺血性心力衰竭(IHF)患者不良结局之间的关联仍不明确。本研究旨在探讨血清Lp(a)水平与IHF患者主要不良心血管事件(MACE)发生率之间的关系。
在这项单中心回顾性队列研究中，纳入了1168例行择期经皮冠状动脉介入治疗(PCI)的IHF患者。根据Lp(a)四分位数将患者分为四组。主要终点为MACE，定义为全因死亡率、非致死性心肌梗死(MI)和任何血管重建术的复合终点。采用Cox比例风险模型评估Lp(a)四分位数与不良结局之间的关联。构建受限立方样条(RCS)曲线以探讨Lp(a)水平与MACE风险之间的非线性关系。进行亚组分析以研究不同亚组中的关联。
MACE的发生率在Lp(a)四分位数间显著增加(四分位数4与四分位数1：46.4%对22.9%，P<0.001)。在调整混杂因素后，Lp(a)最高组仍与MACE风险增加独立相关(HR，95%CI：2.28，1.69 - 3.07，P<0.001，趋势P<0.001)、全因死亡率(HR，95%CI：2.33，1.54 - 3.54，P<0.001，趋势P = 0.01)和任何血管重建术(HR，95%CI：2.18，1.35 - 3.53，P = 0.002，趋势P = 0.001)。RCS模型显示Lp(a)水平与MACE风险之间存在非线性正相关。亚组分析显示与体重指数(BMI)存在显著交互作用，在BMI较高的患者中观察到更强的关联(交互作用P<0.001)。
Lp(a)水平升高与IHF患者MACE、死亡率和血管重建术风险增加独立相关，在肥胖个体中作用更强。
