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脂質関連のマーカーと心血管疾患の予測

, Emanuele Di Angelantonio, Pei Gao

|July 17, 2012

まとめ

アポリポプロテインB/A-I,リポプロテインa,リポプロテイン関連フォスホリパースA2などの新興脂質マーカーの評価は,最初の心血管疾患 (CVD) の予測にわずかな改善をもたらします. これらのマーカーは,潜在的なスタチン療法のための中間リスクのある個人を再分類するのに役立ちます.

科学分野:

心血管疾患に関する研究
脂質代謝とバイオマーカー
予防的な心臓病学

背景:

初期心血管疾患を予測するための新しい脂質関連マーカーの臨床的有用性は,依然として調査中です.
既存のリスク予測モデルは,通常,総コレステロールやHDL-Cなどの従来の脂質プロファイルに依存しています.

研究の目的:

アポリポプロテインBおよびA-I,リポプロテインa,またはリポプロテイン関連フォスフォリファーゼA2を併用することで,心血管疾患 (CVD) のリスク予測が向上するかどうかを評価する.
標準的な脂質測定値 (総コレステロール,HDL-C) に加えると,これらの新興マーカーのインクリメンタル値を評価する.

主な方法:

ベースラインCVDのない165,544人を含む37の潜在的なコホートからの個々の参加者データの分析.
計15,126件のCVDアウトカム (冠動脈疾患と脳卒中) を含め,追跡期間中位は10.4年であった.
10年CVDリスクの低,中,高層の参加者のモデル差別と再分類の評価.

主要な成果:

アポリポプロテインB/A-I,リポプロテインa,またはリポプロテイン関連フォスフォリファーゼA2の添加は,CVDアウトカム差別 (C指数変化) の統計的に有意な改善を示しました.
純再分類の改善は,従来のリスクスコアに追加された場合,ほとんどのマーカーでは控えめ (<1%) であった.
これらのマーカーを用いた検査は,中等リスクの個体のわずかな,しかし有意な割合を特定し,その個人は高リスクのカテゴリーに再分類され,スタチン治療を正当化する可能性がある.

結論:

アポリポプロテインBおよびA-I,リポプロテイン (a),またはリポプロテイン関連フォスフォリパゼA2質量をリスク予測モデルに組み込むことは,CVDリスクの予測にわずかな改善をもたらします.
これらの新興の脂質マーカーは,心血管疾患が確立されていない個体におけるCVDリスク評価の精製に付随する付加価値を提供します.
この発見は,治療決定を導くのに役立つ可能性を示唆しており,特に,当初中等リスクに分類された個体にとって有益である.

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