Fujii Emi, Ako Junya, Takahashi Yuri, Toda Mitsutoshi, Iekushi Kazuma, Yamashita Shizuya
Medical Affairs Division, Novartis Pharma K.K.
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
J Atheroscler Thromb. 2025 Apr 1;32(4):421-438. doi: 10.5551/jat.64953. Epub 2024 Oct 5.
To investigate the distribution of lipoprotein(a) (Lp(a)) and its association with atherosclerotic cardiovascular disease (ASCVD) in Japanese patients at high risk for ASCVD using a health insurance database.
Between July 2013 and June 2021, patients eligible for ASCVD prevention according to the 2017 Japan Atherosclerosis Society (JAS) guidelines with documented Lp(a) test results were extracted from the Medical Data Vision claims database and divided into three groups: primary prevention high-risk (Group I), secondary prevention (Group II) and secondary prevention high-risk (Group III). Data on lipid levels, cardiovascular morbidity risk factors and lipid-lowering treatments were extracted.
Of 700,580 patients with documented low-density lipoprotein cholesterol (LDL-C), 2,967 (0.42%) were tested for Lp(a). In 2,170 eligible patients, the median [interquartile range] serum concentration of Lp(a) was 13.9 [7.5-24.6] mg/dL, with 151 patients (7.0%) above the recommended risk threshold of ≥ 50 mg/dL. Lp(a) levels increased with risk across all prevention groups. Being in the highest Lp(a) quintile (Q5) was associated with an increased frequency of ASCVD (28.9% versus 18.9% in the lowest quintile (Q1) for unstable angina; 18.7% versus 10.1% for myocardial infarction; 27.9% versus 17.0% for ischemic stroke). In the secondary prevention groups, the proportion of patients meeting an LDL-C target of ＜70 mg/dL decreased from 30.2% in Q1 to 19.0% in Q5 for Group II and from 32.9% to 16.3% for Group III.
Despite a high prevalence of Lp(a) ≥ 50mg/dL in Japanese patients at high risk for ASCVD, it found that the Lp(a) testing rate was very low.
利用健康保险数据库调查日本动脉粥样硬化性心血管疾病（ASCVD）高危患者中脂蛋白(a) [Lp(a)] 的分布及其与ASCVD的关联。
在2013年7月至2021年6月期间，从Medical Data Vision理赔数据库中提取根据2017年日本动脉粥样硬化协会（JAS）指南符合ASCVD预防条件且有Lp(a)检测结果记录的患者，并将其分为三组：一级预防高危组（第一组）、二级预防组（第二组）和二级预防高危组（第三组）。提取血脂水平、心血管发病危险因素和降脂治疗的数据。
在700,580例有低密度脂蛋白胆固醇（LDL-C）记录的患者中，2,967例（0.42%）接受了Lp(a)检测。在2,170例符合条件的患者中，Lp(a)的血清浓度中位数[四分位间距]为13.9 [7.5 - 24.6] mg/dL，151例患者（7.0%）高于≥50 mg/dL的推荐风险阈值。在所有预防组中，Lp(a)水平随风险增加而升高。处于Lp(a)最高五分位数（Q5）与ASCVD发生频率增加相关（不稳定型心绞痛：最高五分位数为28.9%，最低五分位数（Q1）为18.9%；心肌梗死：分别为18.7%和10.1%；缺血性卒中：分别为27.9%和17.0%）。在二级预防组中，第二组达到LDL-C目标＜70 mg/dL的患者比例从Q1的30.2%降至Q5的19.0%，第三组从32.9%降至16.3%。
尽管在日本ASCVD高危患者中Lp(a)≥50mg/dL的患病率很高，但发现Lp(a)检测率非常低。
