下肢动脉疾病患者脂蛋白（a）水平分布及其对截肢和生存的影响：一项回顾性研究
Distribution of lipoprotein (a) levels in patients with lower extremity artery disease and their impact on amputation and survival: a retrospective study.
作者信息
Gebauer Katrin, Malyar Nasser M, Varghese Julian, Reinecke Holger, Brix Tobias J, Engelbertz Christiane
机构信息
Department of Cardiology I- Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Cardiol, Muenster, 48149, Germany.
Department of Cardiology I- Coronary and Peripheral Vascular Disease, Heart Failure University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. A1, Muenster, 48149, Germany.
出版信息
Lipids Health Dis. 2025 Apr 2;24(1):128. doi: 10.1186/s12944-025-02542-5.
BACKGROUND
Elevated lipoprotein (a) (Lp(a)) is an independent risk factor for lower extremity artery disease (LEAD) with equivocal effect on amputation and mortality. Results regarding aggressive lipid-lowering therapies (LLT) are missing. We examined LEAD patients with Lp(a) measurement and the impact of intensive LLT on amputation and survival.
METHODS
Baseline characteristics of 263 LEAD patients with Lp(a) measurement treated in a tertiary hospital from 01/2017 until 01/2022 were recorded. Patients were categorized into three groups according to their Lp(a) values (< 30 mg/dL, 30-90 mg/dL and > 90 mg/dL). Lipid values and LLT were recorded at baseline and during follow-up (median 750 days). Peripheral endovascular revascularizations (EVR), amputations and death during follow-up were analysed.
RESULTS
Of 263 patients, 75% were male, mean age was 67 ± 10 years. Elevated Lp(a) values ≥ 30 mg/dL were found in 32%, 16% had values > 90 mg/dL. Baseline low-density lipoprotein cholesterol (LDL-C) was 89 ± 38 mg/dL, decreasing to 61 ± 30 mg/dL at follow-up, with no difference between Lp(a) groups (63 ± 32 mg/dL vs. 52 ± 23 mg/dL vs. 60 ± 25 mg/dL, p = 0.273). Statin dose was intensified more frequently in those with elevated Lp(a) (16% vs. 35% vs. 33%, p = 0.005), who also received significantly more often ezetimibe (50% vs. 58% vs. 73%, p = 0.028) and proprotein convertase subtilisin/kexin type 9 inhibitors (2% vs. 3% vs. 8%, p = 0.043). No difference was seen regarding EVR (91% vs. 95% vs. 90%, p = 0.729), amputations (4% vs. 7% vs. 0%, p = 0.245) and death (8% vs. 5% vs. 3%, p = 0.436).
CONCLUSIONS
Aggressive LLT in high-risk LEAD patients with elevated Lp(a) levels enabled LDL-C target achievement in a majority by combination of established lipid-lowering agents. An increase in EVR, amputation or death could not be observed in patients with high Lp(a) levels.
背景
脂蛋白(a)[Lp(a)]升高是下肢动脉疾病（LEAD）的独立危险因素，对截肢和死亡率的影响尚不明确。关于积极降脂治疗（LLT）的结果尚缺。我们对检测了Lp(a)的LEAD患者以及强化LLT对截肢和生存的影响进行了研究。
方法
记录了2017年1月至2022年1月在一家三级医院接受治疗的263例检测了Lp(a)的LEAD患者的基线特征。根据患者的Lp(a)值（<30mg/dL、30 - 90mg/dL和>90mg/dL）分为三组。在基线和随访期间（中位时间750天）记录血脂值和LLT情况。分析随访期间的外周血管腔内血管重建术（EVR）、截肢和死亡情况。
结果
263例患者中，75%为男性，平均年龄为67±10岁。32%的患者Lp(a)值≥30mg/dL升高，16%的患者值>90mg/dL。基线低密度脂蛋白胆固醇（LDL-C）为89±38mg/dL，随访时降至61±30mg/dL，Lp(a)组之间无差异（63±32mg/dL vs. 52±23mg/dL vs. 60±25mg/dL，p = 0.273）。Lp(a)升高的患者更频繁地强化他汀类药物剂量（16% vs. 35% vs. 33%，p = 0.005），他们也更频繁地接受依折麦布（50% vs. 58% vs. 73%，p = 0.028）和前蛋白转化酶枯草溶菌素/kexin 9型抑制剂（2% vs. 3% vs. 8%，p = 0.043）。在EVR（91% vs. 95% vs. 90%，p = 0.729）、截肢（4% vs. 7% vs. 0%，p = 0.245）和死亡（8% vs. 5% vs. 3%，p = 0.436）方面未见差异。
结论
对于Lp(a)水平升高的高危LEAD患者，通过联合使用已有的降脂药物，积极的LLT使大多数患者实现了LDL-C目标。未观察到Lp(a)水平高的患者EVR、截肢或死亡增加。
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