Lai Yuhui, Zhang Shaozhao, Guo Yue, Xu Chaoguang, Huang Mengting, Zhan Rongjian, Liu Menghui, Xiong Zhenyu, Huang Yiquan, Liao Xinxue, Ma Yuedong, Zhuang Xiaodong, Jiang Jingzhou, Wu Xing
Cardiology Department, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
Am Heart J. 2025 Mar;281:157-167. doi: 10.1016/j.ahj.2024.11.014. Epub 2024 Dec 5.
Elevated lipoprotein(a) (Lp[a]) and apolipoprotein B (apoB) are individually associated with the risk of atherosclerotic cardiovascular disease (ASCVD). Moreover, previous basic research has implicated the potential interaction between apoB and Lp(a) in the atherogenic process. We aimed to determine whether apoB levels significantly modulate ASCVD risk associated with Lp(a) in a large community-based population without baseline cardiovascular disease.
Plasma Lp(a) and apoB were measured in the Atherosclerosis Risk in Communities (ARIC) study. Elevated Lp(a) was defined as the highest race-specific quintile, and elevated apoB was defined as ≥89 mg/dl (median value). The modifying effect of apoB on the Lp(a)-related risk of ASCVD and coronary heart disease (CHD) was determined using Cox regression models adjusted for cardiovascular risk factors.
Among 12,988 ARIC participants, 3,888 ASCVD events and 1754 CHD events were observed. Elevated apoB (≥89 mg/dl) and elevated Lp(a) (race-specific quintile 5) were independently associated with ASCVD (hazard ratio [HR]: 1.19; 95% CI: 1.08-1.30; P <0.001; HR: 1.27; 95% CI: 1.16-1.40; P < .001, respectively). Lp(a)-by-apoB interaction was noted [Lp(a) (quintile 1-4 or quintile 5) * apoB (<89 or ≥89 mg/dl) = 0.002]. Compared to the concordantly low Lp(a) group, the individuals with high Lp(a) had a greater ASCVD risk only when apoB was elevated (HR: 1.48; 95% CI: 1.34-1.63; P < .001).
In the context of primary prevention, ASCVD risk associated with Lp(a) was observed only when apoB was elevated. The measurement of apoB can further refine and contextualize the ASCVD risk associated with Lp(a).
脂蛋白(a)[Lp(a)]和载脂蛋白B(apoB)升高分别与动脉粥样硬化性心血管疾病(ASCVD)风险相关。此外，先前的基础研究表明apoB与Lp(a)在动脉粥样硬化形成过程中可能存在相互作用。我们旨在确定在一个无基线心血管疾病的大型社区人群中，apoB水平是否会显著调节与Lp(a)相关的ASCVD风险。
在社区动脉粥样硬化风险(ARIC)研究中测量血浆Lp(a)和apoB。Lp(a)升高定义为种族特异性最高五分位数，apoB升高定义为≥89mg/dl(中位数)。使用针对心血管危险因素进行调整的Cox回归模型确定apoB对Lp(a)相关的ASCVD和冠心病(CHD)风险的调节作用。
在12988名ARIC参与者中，观察到3888例ASCVD事件和1754例CHD事件。apoB升高(≥89mg/dl)和Lp(a)升高(种族特异性五分位数5)分别与ASCVD独立相关(风险比[HR]：1.19；95%置信区间：1.08-1.30；P<0.001；HR：1.27；95%置信区间：1.16-1.40；P<0.001)。观察到Lp(a)与apoB的相互作用[Lp(a)(五分位数1-4或五分位数5)*apoB(<89或≥89mg/dl)=0.0
