Nomura Sarah, Guan Weihua, Zhang Yixin, Tison Geoffrey H, Ikezaki Hiroaki, Diffenderfer Margaret R, Liu Ching-Ti, Hoogeveen Ron C, Ballantyne Christie M, Schaefer Ernst J, Tsai Michael Y
Department of Laboratory Medicine and Pathology University of Minnesota Minneapolis MN USA.
Division of Biostatistics School of Public Health, University of Minnesota Minneapolis MN USA.
J Am Heart Assoc. 2025 Jun 3;14(11):e038608. doi: 10.1161/JAHA.124.038608. Epub 2025 May 26.
BACKGROUND: This study investigated Lp(a) (lipoprotein(a)) levels with heart failure (HF) incidence overall and ejection fraction (EF) subtypes among Black and White participants in a pooled analysis of MESA (Multi-Ethnic Study of Atherosclerosis), FOS (Framingham Offspring Study), and ARIC (Atherosclerosis Risk in Communities Study). METHODS: This study was conducted among 16 771 White and Black participants in ARIC (N=10 347), MESA (N=4150), and FOS (N=2274). Baseline was time of Lp(a) measurement (ARIC Visit 4: 1996-1998; MESA Visit 1: 2000-2002; FOS Cycle 6: 1995-1998). HF with reduced EF (HFrEF) was defined as EF <50% and ≥50% as HF with preserved EF (HFpEF). Cox proportional hazards regression was used to evaluate associations between Lp(a) (log-transformed continuous, dichotomized at ≥30 mg/dL and ≥50 mg/dL, and quartiles) and HF (overall, HFpEF, HFrEF) in the overall population and stratified by race. Analyses were replicated excluding prior history of myocardial infarction. RESULTS: There were 2759 HF cases (HFpEF N=859; HFrEF N=649; EF unknown N=1251) through 2019. Among White participants, Lp(a) ≥50 mg/dL was associated with HF risk overall (hazard ratio [HR], 1.19 [95% CI, 1.07-1.34]) and by EF subtype (HFpEF HR, 1.32 [95% CI, 1.08-1.59]; HFrEF HR, 1.33 [95% CI, 1.05-1.67]). Among Black participants, Lp(a) ≥50 mg/dL was not associated with HF risk overall (HR, 0.93 [95% CI, 0.78-1.11]) or by EF subtype (HFpEF HR, 0.97 [95% CI, 0.69-1.35]; HFrEF HR, 0.89 [95% CI, 0.63-1.26]). Associations were no longer significant after excluding prior myocardial infarction. CONCLUSIONS: Elevated Lp(a) levels are associated with HF risk among White, but not Black individuals, and associations appears to be mostly mediated by a history of myocardial infarction.
背景:本研究在动脉粥样硬化多民族研究(MESA)、弗雷明汉心脏研究后代队列(FOS)和社区动脉粥样硬化风险研究(ARIC)的汇总分析中,调查了黑人和白人参与者中脂蛋白(a)[Lp(a)]水平与心力衰竭(HF)总体发病率及射血分数(EF)亚型之间的关系。 方法:本研究在ARIC(N = 10347)、MESA(N = 4150)和FOS(N = 2274)的16771名白人和黑人参与者中进行。基线为Lp(a)测量时间(ARIC第4次访视:1996 - 1998年;MESA第1次访视:2000 - 2002年;FOS第6轮:1995 - 1998年)。射血分数降低的心力衰竭(HFrEF)定义为EF < 50%,EF≥50%为射血分数保留的心力衰竭(HFpEF)。采用Cox比例风险回归评估总体人群及按种族分层后Lp(a)(对数转换后的连续变量,按≥30mg/dL和≥50mg/dL二分法以及四分位数分组)与HF(总体、HFpEF、HFrEF)之间的关联。排除既往心肌梗死病史后重复进行分析。 结果:截至2019年,共有2759例HF病例(HFpEF为859例;HFrEF为649例;EF情况未知为1251例)。在白人参与者中,Lp(a)≥50mg/dL与总体HF风险相关(风险比[HR],1.19[95%CI,1.07 - 1.34]),并与EF亚型相关(HFpEF的HR为1.32[95%CI,1.08 - 1.59];HFrEF的HR为1.33[95%CI,1.05 - 1.67])。在黑人参与者中,Lp(a)≥50mg/dL与总体HF风险无关(HR,0.93[95%CI,0.78 - 1.11]),也与EF亚型无关(HFpEF的HR为0.97[95%CI,0.69 - 1.35];HFrEF的HR为0.89[95%CI,0.63 - 1.26])。排除既往心肌梗死病史后,这些关联不再显著。 结论:Lp(a)水平升高与白人个体的HF风险相关,但与黑人个体无关,且这种关联似乎主要由心肌梗死病史介导。
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