脂蛋白(a)是白人男性外周过早动脉粥样硬化的一个独立的、有鉴别意义的危险因素。

Lp(a) lipoprotein is an independent, discriminating risk factor for premature peripheral atherosclerosis among white men.

作者信息

Valentine R J, Grayburn P A, Vega G L, Grundy S M

机构信息

Department of Surgery, Veterans Affairs Medical Center, Dallas.

出版信息

Arch Intern Med. 1994 Apr 11;154(7):801-6.

PMID:8147686

Abstract

BACKGROUND

Elevated plasma levels of Lp(a) lipoprotein have been linked to the development of premature atherosclerosis in the coronary circulation (coronary artery disease [CAD]). Although Lp(a) lipoprotein has been implicated as a risk factor for premature atherosclerosis in other locations, the patient populations described were not carefully screened for the coexistence of premature CAD. The purpose of this prospective study was to determine whether carefully screened patients with premature peripheral vascular disease (PVD) have elevated plasma levels of Lp(a) lipoprotein and to test the relative strength of Lp(a) lipoprotein level as a risk factor for premature PVD.

METHODS

We studied 55 consecutive white men with premature PVD (onset at 45 years of age or earlier) presenting to our vascular laboratory. Study subjects were substratified into 17 with PVD only and 38 with combined PVD and CAD (PVD + CAD). Two comparison groups included 26 age-matched white men with premature CAD recruited from the Cardiology Service after cardiac catheterization and 32 age-matched white male controls recruited from outpatient clinics.

RESULTS

Mean plasma apolipoprotein B-100 levels were higher in the CAD group than in controls (P = .013). Mean plasma Lp(a) lipoprotein levels were higher among the 17 patients with PVD only than among controls (P = .008). The covariance-adjusted mean Lp(a) lipoprotein levels were higher among all 55 patients with PVD than among controls (P = .014). Logistic regression analysis demonstrated two variables to be significantly related to premature PVD: Lp(a) lipoprotein level greater than 30 mg/dL (odds ratio, 3.9; 95% confidence interval, 1.1 to 13.7) and apolipoprotein B level greater than 95 mg/dL (odds ratio, 3.2; 95% confidence interval, 1.0 to 10.0).

CONCLUSIONS

Lp(a) lipoprotein level is an independent, discriminating risk factor for premature PVD among white men.

摘要

背景

血浆中脂蛋白(a)[Lp(a)]水平升高与冠状动脉循环中过早发生动脉粥样硬化（冠状动脉疾病[CAD]）有关。尽管Lp(a)脂蛋白被认为是其他部位过早发生动脉粥样硬化的危险因素，但所描述的患者群体并未针对过早发生CAD的共存情况进行仔细筛查。这项前瞻性研究的目的是确定经过仔细筛查的过早发生外周血管疾病（PVD）患者血浆中Lp(a)脂蛋白水平是否升高，并检验Lp(a)脂蛋白水平作为过早发生PVD的危险因素的相对强度。

方法

我们研究了连续55名过早发生PVD（发病年龄在45岁及以下）并到我们血管实验室就诊的白人男性。研究对象被分为仅患有PVD的17例和合并PVD与CAD（PVD+CAD）的38例。两个对照组包括26例在心脏导管插入术后从心脏病科招募的年龄匹配的过早发生CAD的白人男性，以及32例从门诊诊所招募的年龄匹配的白人男性对照。

结果

CAD组的平均血浆载脂蛋白B-100水平高于对照组（P=0.013）。仅患有PVD的17例患者的平均血浆Lp(a)脂蛋白水平高于对照组（P=0.008）。所有55例PVD患者经协方差调整后的平均Lp(a)脂蛋白水平高于对照组（P=0.014）。逻辑回归分析表明，有两个变量与过早发生PVD显著相关：Lp(a)脂蛋白水平大于30mg/dL（比值比，3.9；95%置信区间，1.1至13.7）以及载脂蛋白B水平大于95mg/dL（比值比，3.2；95%置信区间，1.0至10.0）。