Sentí M, Pedro-Botet J, Pavesi M, Marrugat J, Aubó C, Pena A, Martín S, Rubiés-Prat J
Lipids and Cardiovascular Epidemiology Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
Clin Chim Acta. 1997 Aug 29;264(2):193-205. doi: 10.1016/s0009-8981(97)00093-4.
Family history of atherosclerosis has been recognised as an nonmodifiable cardiovascular risk factor. Lipid levels, together with hypertension and diabetes, appear to have an inheritable component. The aim of the study was to ascertain whether lipoprotein abnormalities of 169 adult patients with non-coronary atherosclerosis were associated with a family history of atherosclerosis. Besides intermediate density lipopoprotein composition and Lp(a) levels, we focused on apo(a) and apo E phenotypes, LDL cholesterol/apo B ratio, VLDL triglyceride/HDL cholesterol ratio, and environmental factors. We found that patients with a family history of atherosclerosis had a higher prevalence of VLDL triglyceride/HDL cholesterol ratio above 1.8 (51.3% vs 34.7%) than patients without. Similarly, there was a significant inverse correlation between both considered ratios (r = -0.24, p < 0.05). The odds ratio of the presence of both abnormal ratios (4.60, 95% CI, 1.41-15.00) and low molecular weight apo(a) isoforms (3.30, 95% CI, 1.05-10.30 and family history of atherosclerosis was independent of smoking and hypertension. Apo(a) isoform size seems to be more important than Lp(a) concentrations in the family history of atherosclerosis risk determination. Subsequent analysis showed that patients with a family history of atherosclerosis had a greater-than-fourfold increased risk of having one or both abnormal ratios reflecting metabolic disturbances which probably constitute a combined trait. Family history of atherosclerosis may constitute a specific lipoprotein-related marker of atherosclerosis. Such a marker often precedes the onset of overt disease and may contribute to identifying patients with an atherogenic lipoprotein profile even in the absence of classical lipid risk factors.
动脉粥样硬化家族史已被公认为一种不可改变的心血管危险因素。血脂水平与高血压和糖尿病一样，似乎具有遗传成分。本研究的目的是确定169例非冠状动脉粥样硬化成年患者的脂蛋白异常是否与动脉粥样硬化家族史有关。除了中密度脂蛋白组成和Lp(a)水平外，我们还关注载脂蛋白(a)和载脂蛋白E表型、低密度脂蛋白胆固醇/载脂蛋白B比值、极低密度脂蛋白甘油三酯/高密度脂蛋白胆固醇比值以及环境因素。我们发现，有动脉粥样硬化家族史的患者极低密度脂蛋白甘油三酯/高密度脂蛋白胆固醇比值高于1.8的患病率（51.3%对34.7%）高于无家族史的患者。同样，两个考虑的比值之间存在显著的负相关（r = -0.24，p < 0.05）。两种异常比值同时存在（比值比为4.60，95%可信区间为1.41 - 15.00）和低分子量载脂蛋白(a)异构体（比值比为3.30，95%可信区间为1.05 - 10.30）以及动脉粥样硬化家族史与吸烟和高血压无关。在动脉粥样硬化风险判定的家族史中，载脂蛋白(a)异构体大小似乎比Lp(a)浓度更重要。后续分析表明，有动脉粥样硬化家族史的患者出现一种或两种反映代谢紊乱的异常比值的风险增加了四倍多，这可能构成一种综合特征。动脉粥样硬化家族史可能构成动脉粥样硬化的一种特定的脂蛋白相关标志物。这种标志物通常在明显疾病发作之前出现，甚至在没有经典脂质危险因素的情况下，也可能有助于识别具有致动脉粥样硬化脂蛋白谱的患者。
