脂蛋白(a)、胆固醇、甘油三酯水平与易损冠状动脉斑块：PROSPECT II子研究
Lipoprotein(a), Cholesterol, Triglyceride Levels, and Vulnerable Coronary Plaques: A PROSPECT II Substudy.
作者信息
Erlinge David, Tsimikas Sotirios, Maeng Michael, Maehara Akiko, Larsen Alf Inge, Engstrøm Thomas, Kjøller-Hansen Lars, Matsumura Mitsuaki, Ben-Yehuda Ori, Bøtker Hans Erik, Fröbert Ole, Persson Jonas, Wiseth Rune, Jensen Lisette O, Nordrehaug Jan E, Trovik Thor, Jensen Ulf, Bleie Øyvind, Omerovic Elmir, James Stefan K, Rylance Rebecca, Sharma Tania, Ali Ziad A, Stone Gregg W
机构信息
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Sulpizio Cardiovascular Center, Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA.
出版信息
J Am Coll Cardiol. 2025 Jun 3;85(21):2011-2024. doi: 10.1016/j.jacc.2025.04.013.
BACKGROUND
Although lipoprotein(a) (Lp[a]) has been associated with acute myocardial infarction (MI), the relationship between Lp(a) and the presence of high-risk "vulnerable" coronary plaques has not been studied.
OBJECTIVES
The aim of this study was to investigate whether specific lipoproteins are associated with pancoronary plaque volume and lipid deposition vs the development of non-flow-limiting high-risk vulnerable plaques.
METHODS
In PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II, 3-vessel coronary artery imaging was performed with a combined near-infrared spectroscopy and intravascular ultrasound catheter after treatment of all flow-limiting lesions in patients with recent MI. The relationships of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), HDL-C, Lp(a), and triglycerides to pancoronary plaque volume, pancoronary lipid core burden index (LCBI), and the presence of focal vulnerable plaques (plaque burden ≥70% and maximum LCBI over any 4-mm segment ≥324.7) were assessed in 865 patients.
RESULTS
By multivariable analysis, TC, LDL-C, and non-HDL-C (but not Lp[a]) were associated with pancoronary plaque volume and pancoronary LCBI (P < 0.01 for all), but not with the presence of vulnerable plaque. Conversely, Lp(a) (but not TC, LDL-C, or non-HDL-C) was associated with the presence of focal vulnerable plaques (P = 0.01).
CONCLUSIONS
In PROSPECT II, elevated TC, LDL-C, and non-HDL-C were strongly associated with pancoronary atherosclerosis and lipid deposition, whereas elevated Lp(a) was strongly associated with the presence of focal vulnerable plaques. These findings may explain the association between high Lp(a) levels and future MI and suggest a unique role for Lp(a) role in atherosclerosis progression and plaque vulnerability. (PROSPECT II & PROSPECT ABSORB-An Integrated Natural History Study and Randomized Trial; NCT02171065).
背景
尽管脂蛋白(a)[Lp(a)]与急性心肌梗死(MI)有关，但Lp(a)与高危“易损”冠状动脉斑块的存在之间的关系尚未得到研究。
目的
本研究旨在调查特定脂蛋白是否与全冠状动脉斑块体积和脂质沉积有关，以及与非血流限制性高危易损斑块的发生有关。
方法
在PROSPECT(提供区域观察以研究冠状动脉树中事件的预测因子)II研究中，对近期心肌梗死患者的所有血流限制性病变进行治疗后，使用近红外光谱和血管内超声导管联合进行三支血管冠状动脉成像。在865例患者中评估了总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(non-HDL-C)、高密度脂蛋白胆固醇(HDL-C)、Lp(a)和甘油三酯与全冠状动脉斑块体积、全冠状动脉脂质核心负担指数(LCBI)以及局灶性易损斑块(斑块负荷≥70%且任何4毫米节段的最大LCBI≥324.7)存在之间的关系。
结果
通过多变量分析，TC、LDL-C和non-HDL-C(而非Lp[a])与全冠状动脉斑块体积和全冠状动脉LCBI相关(所有P<0.01)，但与易损斑块的存在无关。相反，Lp(a)(而非TC、LDL-C或non-HDL-C)与局灶性易损斑块的存在相关(P=0.01)。
结论
在PROSPECT II研究中，升高的TC、LDL-C和non-HDL-C与全冠状动脉粥样硬化和脂质沉积密切相关，而升高的Lp(a)与局灶性易损斑块的存在密切相关。这些发现可能解释了高Lp(a)水平与未来心肌梗死之间的关联，并提示Lp(a)在动脉粥样硬化进展和斑块易损性方面具有独特作用。(PROSPECT II和PROSPECT ABSORB-一项综合自然史研究和随机试验；NCT02171065)
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