Kinlay S, Dobson A J, Heller R F, McElduff P, Alexander H, Dickeson J
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Royal Newcastle Hospital, New South Wales, Australia.
J Am Coll Cardiol. 1996 Oct;28(4):870-5. doi: 10.1016/s0735-1097(96)00238-0.
This study sought to examine whether lipoprotein(a) concentrations were risk factors for a first acute and recurrent myocardial infarction.
There is conflicting evidence concerning the risk of acute myocardial infarction from lipoprotein(a). No studies have examined the risk of recurrent acute myocardial infarction from lipoprotein(a), and few have addressed the risk in women.
This was a population-based case-control study of 893 men and women 35 to 69 years old participating in the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Project in Newcastle, Australia in 1993 to 1994. Case and control patients were classified into those with and without a previous myocardial infarction, and median lipoprotein(a) concentrations were compared after adjusting for other variables. Quintiles of lipoprotein(a) concentration were also examined.
Compared with control subjects without a previous myocardial infarction, median lipoprotein(a) concentrations increased from case patients with a first myocardial infarction (15 mg/liter higher, 95% confidence interval [CI] -36 to 60) to control patients with a previous myocardial infarction (159 mg/ liter higher, 95% CI 40 to 278) and case patients with a previous myocardial infarction (60 mg/liter higher, 95% CI -16 to 136, p < 0.01, test for trend). Women had significantly higher lipoprotein(a) concentrations than men (median 71 mg/liter higher, 95% CI 23 to 118). The highest quintile of lipoprotein(a) (>550 mg/liter) was a significant risk factor for a first acute myocardial infarction (odds ratio [OR] 1.77, 95% CI 1.03 to 3.03); but in those with a previous myocardial infarction, the highest quintile was not associated with recurrent myocardial infarction (OR 0.84, 95% CI 0.30 to 2.37).
High lipoprotein(a) concentrations may be a marker of vascular or tissue injury or may be associated with other genetic or environmental factors that cause acute myocardial infarction. Currently, lipoprotein(a) measurement cannot be recommended for assessment of risk for acute myocardial infarction.
本研究旨在探讨脂蛋白(a)浓度是否为首次急性心肌梗死和复发性心肌梗死的危险因素。
关于脂蛋白(a)导致急性心肌梗死风险的证据存在冲突。尚无研究探讨脂蛋白(a)导致复发性急性心肌梗死的风险，且很少有研究涉及女性的风险。
这是一项基于人群的病例对照研究，研究对象为1993年至1994年参与澳大利亚纽卡斯尔世界卫生组织心血管疾病监测趋势和决定因素（MONICA）项目的893名年龄在35至69岁之间的男性和女性。病例组和对照组患者分为有或无既往心肌梗死的患者，并在调整其他变量后比较脂蛋白(a)的中位数浓度。还对脂蛋白(a)浓度的五分位数进行了研究。
与无既往心肌梗死的对照组相比，脂蛋白(a)的中位数浓度从首次心肌梗死的病例患者（高15毫克/升，95%置信区间[CI]-36至60）增加到有既往心肌梗死的对照患者（高159毫克/升，95%CI40至278）和有既往心肌梗死的病例患者（高60毫克/升，95%CI-16至136，p<0.01，趋势检验）。女性的脂蛋白(a)浓度显著高于男性（中位数高71毫克/升，95%CI23至118）。脂蛋白(a)最高五分位数（>550毫克/升）是首次急性心肌梗死的显著危险因素（比值比[OR]1.77，95%CI1.03至3.03）；但在有既往心肌梗死的患者中，最高五分位数与复发性心肌梗死无关（OR0.84，95%CI0.30至2.37）。
高脂蛋白(a)浓度可能是血管或组织损伤的标志物，或可能与导致急性心肌梗死的其他遗传或环境因素有关。目前，不建议将脂蛋白(a)检测用于评估急性心肌梗死风险。
