Li Sha, Liu Hui-Hui, Zhang Yan, Zhang Meng, Zhang Hui-Wen, Zhu Cheng-Gang, Wu Na-Qiong, Xu Rui-Xia, Dong Qian, Qian Jie, Dou Ke-Fei, Guo Yuan-Lin, Li Jian-Jun
Cardiometabolic Center State Key Laboratory of Cardiovascular Disease FuWai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College Beijing China.
MedComm (2020). 2024 Oct 31;5(11):e773. doi: 10.1002/mco2.773. eCollection 2024 Nov.
Lipoprotein(a) [Lp(a)] is an emerging predictor for atherosclerotic cardiovascular disease (ASCVD) but the association from a perspective on current risk stratification was unknown. A cohort of 9944 Chinese patients with ASCVD was recruited and refined into very-high-risk (VHR) and non-VHR subgroups according to current guideline. Lp(a) plasma levels were divided by its concentration (<30, 30-50, 50-75, and ≥75 mg/dL) and percentile zones (<25th, 25-50th, 50-75th, 75-90th, ≥90th). Cardiovascular events (CVEs) occurred during an average of 38.5 months' follow-up were recorded. We found that Lp(a) was increased with risk stratification of ASCVD increasing. Prevalence of CVEs had a significantly increasing trend with gradients of Lp(a) elevation in VHR but not in non-VHR subgroup. The adjusted HRs (95%CIs) for CVEs were 1.75(1.25-2.46) in the highest group of Lp(a) ≥75 mg/dL compared with the group of Lp(a) <30 mg/dL as the reference in overall patients, 2.18(1.32-3.58) in VHR subgroup and 1.43(0.93-2.18) in non-VHR subgroup, respectively. The adjusted HRs (95%CIs) at the highest grade of Lp(a) levels (≥90th) were 1.72(1.19-2.50) in overall population, 2.83(1.53-5.24) in VHR subgroup and 1.38(0.86-2.12) in non-VHR subgroup, respectively. These findings suggested that Lp(a) might contribute more to CVEs risk in VHR subgroup of ASCVD.
脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的一个新的预测指标，但从当前风险分层的角度来看其相关性尚不清楚。招募了9944名中国ASCVD患者队列，并根据当前指南将其细化为极高风险(VHR)和非VHR亚组。Lp(a)血浆水平根据其浓度(<30、30 - 50、50 - 75和≥75mg/dL)和百分位数区间(<25th、25 - 50th、50 - 75th、75 - 90th、≥90th)进行划分。记录平均38.5个月随访期间发生的心血管事件(CVE)。我们发现Lp(a)随着ASCVD风险分层的增加而升高。在VHR亚组中，CVE的患病率随Lp(a)升高梯度有显著增加趋势，但在非VHR亚组中无此趋势。在总体患者中，以Lp(a)<30mg/dL组为参照，Lp(a)≥75mg/dL最高组CVE的校正HR(95%CI)为1.75(1.25 - 2.46)，在VHR亚组中为2.18(1.32 - 3.58)，在非VHR亚组中为1.43(0.93 - 2.18)。在Lp(a)水平最高等级(≥90th)时，总体人群校正HR(95%CI)为1.72(1.19 - 2.50)，VHR亚组为2.83(1.53 - 5.24)，非VHR亚组为1.38(0.86 - 2.12)。这些发现表明，Lp(a)可能在ASCVD的VHR亚组中对CVE风险的影响更大。
