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社区动脉粥样硬化风险研究、弗雷明汉心脏研究及多民族动脉粥样硬化研究中黑人和白人参与者的脂蛋白(a)与心力衰竭:汇总项目

Lipoprotein(a) and Heart Failure Among Black and White Participants in Atherosclerosis Risk in Communities Study, Framingham Offspring Study, and Multi-Ethnic Study of Atherosclerosis: The Pooling Project.

作者信息

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

机构信息

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.

出版信息

J Am Heart Assoc. 2025 Jun 3;14(11):e038608. doi: 10.1161/JAHA.124.038608. Epub 2025 May 26.


DOI:10.1161/JAHA.124.038608
PMID:40417812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12229190/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/74b4de425acc/JAH3-14-e038608-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/dc452e6a48a6/JAH3-14-e038608-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/ce33aa3e5c1d/JAH3-14-e038608-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/74b4de425acc/JAH3-14-e038608-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/dc452e6a48a6/JAH3-14-e038608-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/ce33aa3e5c1d/JAH3-14-e038608-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aa04/12229190/74b4de425acc/JAH3-14-e038608-g001.jpg

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本文引用的文献

[1]
Lipoprotein(a) and Long-Term Cardiovascular Risk in a Multi-Ethnic Pooled Prospective Cohort.

J Am Coll Cardiol. 2024-4-23

[2]
Lipoprotein (a), Inflammation, and Atherosclerosis.

J Clin Med. 2023-3-27

[3]
Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study.

J Am Heart Assoc. 2022-9-6

[4]
Multi-system trajectories and the incidence of heart failure in the Framingham Offspring Study.

PLoS One. 2022-5-26

[5]
Lipoprotein(a) and ethnicities.

Atherosclerosis. 2022-5

[6]
Association between lipoprotein (a) and heart failure with reduced ejection fraction development.

J Clin Lab Anal. 2022-1

[7]
Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association.

Arterioscler Thromb Vasc Biol. 2022-1

[8]
High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a): Multi-Ethnic Study of Atherosclerosis.

J Am Coll Cardiol. 2021-9-14

[9]
The ARIC (Atherosclerosis Risk In Communities) Study: JACC Focus Seminar 3/8.

J Am Coll Cardiol. 2021-6-15

[10]
Racial and ethnic disparities in heart failure: current state and future directions.

Curr Opin Cardiol. 2021-5-1

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