Jang Mi-Hee, Park Sangwoo, Ann Soe Hee, Kim Yong-Giun, Jeon Young-Jee, Lim Soyeoun, Kwon Woon Jung, Choi Seong Hoon, Han Seungbong, Park Gyung-Min
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 25, Daehakbyeongwon-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Sci Rep. 2025 Jul 1;15(1):20436. doi: 10.1038/s41598-025-04964-8.
The relationship between subclinical coronary atherosclerosis and lipoprotein(a) (Lp[a]) in asymptomatic people with and without diabetes mellitus (DM) is not well understood. We conducted a retrospective analysis of 7201 asymptomatic people (average age 54.4 ± 7.9 years; 65.3% male) who voluntarily had coronary computed tomography angiography (CCTA) as part of a general health evaluation and had no history of coronary artery disease (CAD). The severity and extent of subclinical coronary atherosclerosis were assessed using CCTA, with obstructive CAD defined as a diameter stenosis of at least 50%. Based on their Lp(a) levels, the study participants were divided into tertiles. To assess the relationship between Lp(a) levels and subclinical coronary atherosclerosis, logistic regression analysis was used. In participants without DM (n = 6252), after adjusting for cardiovascular risk factors, there were no statistically significant differences in the adjusted odds ratios (ORs) for calcified plaque, mixed plaque, non-calcified plaque, and obstructive CAD in the third Lp(a) tertile compared to the first tertile (p > 0.05 for all). On the other hand, in participants with DM (n = 949), there were no statistically significant differences in the ORs for calcified plaque (1.117, 95% confidence interval [CI] 0.794-1.572), mixed plaque (1.552, 95% CI 0.888-2.714), or non-calcified plaque (1.735, 95% CI 0.980-3.072) between the first and third Lp(a) tertiles. However, the adjusted ORs for obstructive CAD (2.051, 95% CI 1.248-3.372) were significantly higher in the third Lp(a) tertile compared to the first Lp(a) tertile. In asymptomatic individuals with DM, higher Lp(a) levels were associated with obstructive CAD, which may be linked to an increased risk of cardiac events.
在无症状的糖尿病患者和非糖尿病患者中，亚临床冠状动脉粥样硬化与脂蛋白(a)[Lp(a)]之间的关系尚未完全明确。我们对7201名无症状者（平均年龄54.4±7.9岁；65.3%为男性）进行了一项回顾性分析，这些人自愿接受冠状动脉计算机断层扫描血管造影（CCTA）作为一般健康评估的一部分，且无冠状动脉疾病（CAD）病史。使用CCTA评估亚临床冠状动脉粥样硬化的严重程度和范围，阻塞性CAD定义为直径狭窄至少50%。根据Lp(a)水平，将研究参与者分为三分位数。为了评估Lp(a)水平与亚临床冠状动脉粥样硬化之间的关系，采用了逻辑回归分析。在无糖尿病的参与者（n=6252）中，在调整心血管危险因素后，与第一个Lp(a)三分位数相比，第三个Lp(a)三分位数在钙化斑块、混合斑块、非钙化斑块和阻塞性CAD的调整优势比（OR）方面无统计学显著差异（所有p>0.05）。另一方面，在糖尿病患者（n=949）中，第一个和第三个Lp(a)三分位数在钙化斑块（1.117，95%置信区间[CI]0.794-1.572）、混合斑块（1.552，95%CI0.888-2.714）或非钙化斑块（1.735，95%CI0.980-3.072）的OR方面无统计学显著差异。然而，与第一个Lp(a)三分位数相比，第三个Lp(a)三分位数的阻塞性CAD调整OR（2.051，95%CI1.248-3.372）显著更高。在无症状的糖尿病个体中，较高的Lp(a)水平与阻塞性CAD相关，这可能与心脏事件风险增加有关。
