Dahlén G H, Weinehall L, Stenlund H, Jansson J H, Hallmans G, Huhtasaari F, Wall S
Department of Clinical Chemistry, Umeå University, Sweden.
J Intern Med. 1998 Nov;244(5):425-30. doi: 10.1046/j.1365-2796.1998.00422.x.
To further establish the importance of total plasma apolipoprotein A-I and lipoprotein(a) in the prediction of primary acute myocardial infarction (AMI) in men.
An incident case-control study.
The study was nested within the Västerbotten Intervention Program (VIP) and the Northern Sweden MONICA cohorts.
A total of 62 male AMI cases and 124 matched controls, randomly selected from the study cohorts.
In multivariate logistic regression, significant odds ratios (OR) were found for Lp(a) above 200 mg L-1, apo A-I below the mean value (1136 mg L-1) and total cholesterol (TC) above 7.8 mmol L-1. TC interacted significantly with Lp(a); for Lp(a) above 200 mg L-1 and TC below 6.5 mmol L-1, OR = 5.6; for Lp(a) above 200 mg L-1 and TC above 6.5 mmol L-1, OR = 12.6. To evaluate the potential effect of reducing high levels of Lp(a) or TC on the incidence of AMI in males, the attributable risk percentage (ARP) was calculated when interaction between the two variables was present. ARP is 31% for Lp(a) and 21% for TC, implying that 31% of the cases are due to high Lp(a) and 21% of the cases are due to high TC levels.
In the Swedish male population, total apo A-I in plasma is a protective factor and a plasma Lp(a) level above 200 mg L-1 is a risk factor for AMI in males. A TC level above 6.5 mmol L-1 increased the risk of AMI if the Lp(a) level was above 200 mg L-1, suggesting Lp(a) to be useful in identifying high risk individuals needed to be treated.
进一步确立血浆总载脂蛋白A-I和脂蛋白(a)在预测男性原发性急性心肌梗死（AMI）中的重要性。
一项病例对照研究。
该研究嵌套于韦斯特博滕干预项目（VIP）和瑞典北部莫尼卡队列研究中。
从研究队列中随机选取62例男性AMI病例和124例匹配对照。
在多因素逻辑回归分析中，发现脂蛋白(a)高于200 mg/L、载脂蛋白A-I低于均值（1136 mg/L）以及总胆固醇（TC）高于7.8 mmol/L时，优势比（OR）有显著意义。TC与脂蛋白(a)存在显著交互作用；对于脂蛋白(a)高于200 mg/L且TC低于6.5 mmol/L，OR = 5.6；对于脂蛋白(a)高于200 mg/L且TC高于6.5 mmol/L，OR = 12.6。为评估降低高水平脂蛋白(a)或TC对男性AMI发病率的潜在影响，在两个变量存在交互作用时计算了归因风险百分比（ARP）。脂蛋白(a)的ARP为31%，TC的ARP为21%，这意味着31%的病例归因于高脂蛋白(a)，21%的病例归因于高TC水平。
在瑞典男性人群中，血浆总载脂蛋白A-I是一个保护因素，血浆脂蛋白(a)水平高于200 mg/L是男性AMI的一个危险因素。如果脂蛋白(a)水平高于200 mg/L，TC水平高于6.5 mmol/L会增加AMI风险，这表明脂蛋白(a)有助于识别需要治疗的高危个体。
