State Key Laboratory of Cardiovascular Disease, Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Clin Cardiol. 2024 Oct;47(10):e70025. doi: 10.1002/clc.70025.
Recent studies have suggested that adverse events associated with lipoprotein(a) [Lp(a)] might be modified by low-density lipoprotein cholesterol (LDL-C) or high-sensitivity C-reactive protein (hs-CRP) levels, but whether LDL-C and hs-CRP jointly mediate the outcome of Lp(a) remains unknown in patients with coronary artery disease.
A prospective study was conducted, enrolling consecutive 10 724 patients with percutaneous coronary intervention (PCI) in 2013. The endpoint event was all-cause death. A total of 10 000 patients with complete baseline data were finally included. During a median follow-up of 5.1 years, Lp(a) ≥ 30 mg/dL was an independent risk factor of all-cause death in the overall population, LDL-C ≥ 70 mg/dL, and hs-CRP ≥ 2 mg/L population, respectively. According to concurrent LDL-C (70 mg/dL) and hs-CRP (2 mg/L) levels, further analysis revealed that when LDL-C < 70 mg/dL regardless of hs-CRP levels, Lp(a) ≥ 30 mg/dL was not an independent predictor of all-cause death. However, when LDL-C ≥ 70 mg/dL, Lp(a) ≥ 30 mg/dL was independently associated with a higher risk of all-cause death in hs-CRP ≥ 2 mg/L (HR: 1.488, 95% CI: 1.059‒2.092), but not in hs-CRP < 2 mg/L (HR: 1.303, 95% CI: 0.914‒1.856).
Among PCI patients, Lp(a)-associated outcome was jointly affected by LDL-C and hs-CRP. As long as LDL-C is well controlled, the adverse effects of increased Lp(a) on cardiovascular risk seem to be weakened, and only when LDL-C and hs-CRP increase at the same time, elevated Lp(a) is associated with poorer long-term outcome.
最近的研究表明，脂蛋白(a)[Lp(a)]相关的不良事件可能受到低密度脂蛋白胆固醇（LDL-C）或高敏 C 反应蛋白（hs-CRP）水平的影响，但在患有冠状动脉疾病的患者中，LDL-C 和 hs-CRP 是否共同介导 Lp(a)的结局尚不清楚。
进行了一项前瞻性研究，纳入了 2013 年接受经皮冠状动脉介入治疗（PCI）的连续 10724 例患者。终点事件为全因死亡。最终共纳入了 10000 例具有完整基线数据的患者。在中位随访 5.1 年期间，Lp(a)≥30mg/dL 是总体人群全因死亡的独立危险因素，在 LDL-C≥70mg/dL 和 hs-CRP≥2mg/L 的人群中也是如此。根据同时存在的 LDL-C（70mg/dL）和 hs-CRP（2mg/L）水平，进一步分析显示，无论 hs-CRP 水平如何，当 LDL-C<70mg/dL 时，Lp(a)≥30mg/dL 不是全因死亡的独立预测因素。然而，当 LDL-C≥70mg/dL 时，Lp(a)≥30mg/dL 与 hs-CRP≥2mg/L 时全因死亡风险升高独立相关（HR：1.488，95%CI：1.059‒2.092），但在 hs-CRP<2mg/L 时不相关（HR：1.303，95%CI：0.914‒1.856）。
在 PCI 患者中，Lp(a)相关结局受 LDL-C 和 hs-CRP 的共同影响。只要 LDL-C 得到良好控制，升高的 Lp(a)对心血管风险的不良影响似乎就会减弱，只有当 LDL-C 和 hs-CRP 同时升高时，升高的 Lp(a)才与较差的长期结局相关。
