Orth-Gomér K, Mittleman M A, Schenck-Gustafsson K, Wamala S P, Eriksson M, Belkic K, Kirkeeide R, Svane B, Rydén L
National Institute for Psychosocial Factors and Health, Karolinska Institute, Stockholm, Sweden.
Circulation. 1997 Jan 21;95(2):329-34. doi: 10.1161/01.cir.95.2.329.
Lipoprotein(a) [Lp(a)] appears to be a risk factor for coronary heart disease (CHD) in men. The role of Lp(a) in women, however, is less clear.
We examined the ability of Lp(a) to predict CHD in a population-based case-control study of women 65 years of age or younger who lived in the greater Stockholm area. Subjects were all patients hospitalized for an acute CHD event between February 1991 and February 1994. Control subjects were randomly selected from the city census and were matched to patients by age and catchment area. Lp(a) was measured 3 months after hospitalization by use of an immunoturbidometric method (Incstar) calibrated to the Northwest Lipid Research Laboratories (coefficient of variation was < 9%). Of the 292 consecutive patients, 110 (37%) were hospitalized for an acute myocardial infarction, and 182 were hospitalized (63%) for angina pectoris. The mean age for both patients and control subjects was 56 +/- 7 years. Of participants, 74 patients (25%) and 84 control subjects (29%) were premenopausal. The distributions of Lp(a) were highly skewed in both patients and control subjects, with a range from 0.001 to 1.14 g/L. Age-adjusted odds ratio for CHD in the highest versus the lowest quartile of Lp(a) was 2.3 (95% confidence interval [CI], 1.4 to 3.7). After adjustment for age, smoking, education, body mass index, systolic blood pressure, total cholesterol, triglycerides, and HDL, the odds ratio was 2.9 (95% CI, 1.6 to 5.0). The odds ratios were similar when myocardial infarction and angina patients were compared with their respective control subjects. The odds ratios were 5.1 (95% CI, 1.4 to 18.4) and 2.4 (95% CI, 1.3 to 4.5) in premenopausal and postmenopausal women, respectively.
These results suggest that Lp(a) is a determinant of CHD in both premenopausal and postmenopausal women.
脂蛋白(a)[Lp(a)]似乎是男性冠心病（CHD）的一个危险因素。然而，Lp(a)在女性中的作用尚不清楚。
在一项基于人群的病例对照研究中，我们对居住在大斯德哥尔摩地区65岁及以下的女性进行了研究，以检验Lp(a)预测冠心病的能力。研究对象均为1991年2月至1994年2月因急性冠心病事件住院的患者。对照对象从城市人口普查中随机选取，并按年龄和集水区与患者进行匹配。住院3个月后，采用经西北脂质研究实验室校准的免疫比浊法（Incstar）测量Lp(a)（变异系数<9%）。在292例连续患者中，110例（37%）因急性心肌梗死住院，182例（63%）因心绞痛住院。患者和对照对象的平均年龄均为56±7岁。参与者中，74例患者（25%）和84例对照对象（29%）为绝经前女性。患者和对照对象的Lp(a)分布均高度偏态，范围为0.001至1.14 g/L。Lp(a)最高四分位数与最低四分位数相比，冠心病的年龄调整优势比为2.3（95%置信区间[CI]，1.4至3.7）。在调整年龄、吸烟、教育程度、体重指数、收缩压、总胆固醇、甘油三酯和高密度脂蛋白后，优势比为2.9（95%CI，1.6至5.0）。将心肌梗死患者和心绞痛患者与其各自的对照对象进行比较时，优势比相似。绝经前和绝经后女性的优势比分别为5.1（95%CI，1.4至18.4）和2.4（95%CI，1.3至4.5）。
这些结果表明，Lp(a)是绝经前和绝经后女性冠心病的一个决定因素。
