脂蛋白 (a),C反应蛋白和心血管风险在初级和二级预防人群中
Aeron M Small1,2,3, Ashley Pournamdari4,5, Giorgio E M Melloni6
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA cardiology
|February 14, 2024
概括
升高的脂蛋白a (Lp[a]) 不管炎症如何,都会增加心血管风险. 这一发现适用于初级和二级预防,强调Lp[a]是动脉样硬化心血管疾病 (ASCVD) 的关键危险因素.
科学领域:
- 心血管医学 心血管医学
- 脂质学 脂质学是指脂质学.
- 流行病学 流行病学
背景情况:
- 升高的脂蛋白 (Lp[a]) 是动脉样硬化心血管疾病 (ASCVD) 的已知的危险因素.
- 关于Lp[a]是否仅在存在炎症时才会产生心血管风险,存在相互矛盾的证据.
研究的目的:
- 为了确定Lp[a]是否与高灵敏度C反应蛋白 (hs-CRP) 独立于心血管风险有关.
- 在初级和二级预防群体中调查这一关联.
主要方法:
- 一项队列研究利用来自三个不同的队列的数据:英国生物库 (基于人口),FOURIER试验和SAVOR-TIMI 53试验 (随机临床试验).
- 分析包括评估基线血Lp(a) 和hs-CRP水平.
- 考克斯比例危险模型用于评估主要不良心血管事件 (MACE) 的风险,包括心血管死亡,心肌梗塞 (MI),缺血性中风和外周动脉疾病 (PAD).
主要成果:
- 在英国生物库队列 (n=357,220) 中,较高的Lp(a) 水平与MACE,MI,缺血性中风和PAD的风险增加有关,无论hs-CRP水平如何 (相互作用的P≥.80).
- 在FOURIER和SAVOR试验中 (n=34,020),较高的Lp(a) 也与MACE,MI和PAD风险增加有关,独立于hs-CRP水平 (相互作用P≥.16).
- 对于每50nmol/L高Lp[a]的MACE的危险比为1.02至1.05在不同的hs-CRP层和队列中.
结论:
- 升高的Lp (a) 与在初级和二级预防环境中显著增加MACE,MI和PAD的风险有关.
- 这种关联不管基线hs-CRP水平如何,仍然存在,这表明Lp[a]是一个独立的心血管风险因素.
- 这些发现强调了在心血管风险评估和管理中考虑Lp[a]水平的重要性.
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