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JAHA:脂蛋白(a)和低密度脂蛋白胆固醇同时升高的心血管事件风险

2020-09-06 MedSci原创 MedSci原创

LDL-C≥135mg/dL和脂蛋白(a)≥100nmol/L的同时升高与较高的心血管疾病绝对风险相关。在LDL-C中度升高的个体中进行脂蛋白(a)测量,可能会识别出具有较高心血管风险的个体。

脂蛋白(a)升高是动脉粥样硬化性血管疾病已知的危险因素,但常规临床实践中并未进行测量。在低密度脂蛋白胆固醇(LDL-C)升高的个体中筛查高脂蛋白(a)可能会识别出心血管疾病高风险人群。

近日,心血管疾病领域权威杂志JAHA上发表了一篇研究文章,研究人员对2606名弗雷明汉子代参与者(中位年龄为54岁;男性占45%)进行了前瞻性检查,中位随访时间为15年(n=392例心血管事件)。较高(≥100 nmol/L)和较低脂蛋白(a)患者根据LDL-C<135mg/dL与≥135mg/dL分为四组。

在Cox模型中,在调整了已知的危险因素后,高脂蛋白(a)(≥100nmol/L)和LDL-C≥135mg/dL都是心血管疾病的重要预测指标(LDL-C≥135mg/dL:风险比[HR]为1.34;95%CI为1.09–1.64;P=0.006;高脂蛋白(a):HR为1.31;95%CI为1.03–1.66;P=0.026)。在高/低脂蛋白(a)和LDL-C≥135mg/dL或<135 mg/dL的四组人群中,15年的绝对心血管疾病风险分别为22.6%(高脂蛋白(a)/LDL-C≥135mg/dL,n=248)、17.3%(低脂蛋白(a)/LDL-C≥135mg/dL,n=758)、12.7%(高脂蛋白(a)/LDL-C<135mg/dL,n=275)和11.5%(低脂蛋白(a)/LDL-C<135mg/dL,n=1328,参考组)。在LDL-C≥135mg/dL的个体中,脂蛋白(a)升高的个体的风险增加43%(HR为1.43;95%CI为1.05-1.97;P=0.02)。LDL-C水平中等升高(135-159 mg/dL)的个体高脂蛋白(a)产​​生的绝对风险与LDL-C≥160mg/dL的个体绝对风险相当(23.5%,95%CI为17.4%-31.3%;20.7%,95%CI为16.8%–25.3%)。

由此可见,LDL-C≥135mg/dL和脂蛋白(a)≥100nmol/L的同时升高与较高的心血管疾病绝对风险相关。在LDL-C中度升高的个体中进行脂蛋白(a)测量,可能会识别出具有较高心血管风险的个体。

原始出处:

Mehdi Afshar.et al.Risks of Incident Cardiovascular Disease Associated With Concomitant Elevations in Lipoprotein(a) and Low‐Density Lipoprotein Cholesterol—The Framingham Heart Study.J AM HEART ASSOC.2020.https://www.ahajournals.org/doi/full/10.1161/JAHA.119.014711

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    2020-09-08 zhaohui6731
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    2020-09-07 14818eb4m67暂无昵称

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