Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality.
Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality.
复制标题
DOI：
10.1001/jama.2009.1063
复制
发表时间：
2009-07-22
影响因子：
120.7
通讯作者：
Danesh, John
中科院分区：
文献类型：
--
作者：
Erqou, Sebhat;Kaptoge, Stephen;Perry, Philip L.;Di Angelantonio, Emanuele;Thompson, Alexander;White, Ian R.;Marcovina, Santica M.;Collins, Rory;Thompson, Simon G.;Danesh, John
脂蛋白（a）（Lp[a]）是一种附着在低密度脂蛋白样颗粒上的大糖蛋白，其循环浓度可能与冠心病（CHD）和中风的风险相关。评估Lp（a）浓度与主要血管和非血管结局风险的关系。通过MEDLINE和其他数据库的电子检索、参考文献列表的手动检索以及与合作者的讨论，确定了1970年1月至2009年3月期间发表的记录Lp（a）浓度和随后的主要血管发病率和/或病因特异性死亡率的长期前瞻性研究。在36项前瞻性研究中，为126634名参与者提供了个人记录。在130万人-年的随访中，记录了22076例首次致死性或非致死性血管疾病结局或非血管性死亡，包括9336例CHD结局、1903例缺血性卒中、338例出血性卒中、751例未分类卒中、1091例其他血管性死亡、8114例非血管性死亡和242例不明原因死亡。研究内回归分析调整了人内变异，并使用荟萃分析进行了合并。分析排除了基线时已知既存CHD或卒中的参与者。脂蛋白（a）浓度与几个传统的血管危险因素弱相关，并且在几年内个体内高度一致。Lp（a）与CHD风险的关系在形状上是广泛连续的。在24项队列研究中，基线Lp（a）分布的上三分之一和下三分之一的CHD发生率分别为5.6（95%置信区间[CI]，5.4-5.9）/1000人-年和4.4（95% CI，4.2-4.6）/1000人-年。仅校正年龄和性别后，CHD的风险比为1.16（95%CI，1.11-1.22）/3.5倍的正常Lp（a）浓度（即，每1 SD），进一步校正血脂和其他常规风险因素后，CHD的风险比为1.13（95%CI，1.09-1.18）。缺血性卒中的相应校正风险比为1.10（95%CI，1.02-1.18），非血管性死亡率的总和为1.01（95%CI，0.98-1.05），癌症死亡为1.00（95%CI，0.97-1.04），非血管性死亡（癌症除外）为1.00（95%CI，0.95-1.06）。在广泛的情况下，Lp（a）浓度与CHD和卒中风险之间存在持续、独立和适度的相关性，这些相关性似乎仅限于血管结局。
Circulating concentration of lipoprotein(a) (Lp[a]), a large glycoprotein attached to a low-density lipoprotein–like particle, may be associated with risk of coronary heart disease (CHD) and stroke. To assess the relationship of Lp(a) concentration with risk of major vascular and nonvascular outcomes. Long-term prospective studies that recorded Lp(a) concentration and subsequent major vascular morbidity and/or cause-specific mortality published between January 1970 and March 2009 were identified through electronic searches of MEDLINE and other databases, manual searches of reference lists, and discussion with collaborators. Individual records were provided for each of 126 634 participants in 36 prospective studies. During 1.3 million person-years of follow-up, 22 076 first-ever fatal or nonfatal vascular disease outcomes or nonvascular deaths were recorded, including 9336 CHD outcomes, 1903 ischemic strokes, 338 hemorrhagic strokes, 751 unclassified strokes, 1091 other vascular deaths, 8114 nonvascular deaths, and 242 deaths of unknown cause. Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis. Analyses excluded participants with known preexisting CHD or stroke at baseline. Lipoprotein(a) concentration was weakly correlated with several conventional vascular risk factors and it was highly consistent within individuals over several years. Associations of Lp(a) with CHD risk were broadly continuous in shape. In the 24 cohort studies, the rates of CHD in the top and bottom thirds of baseline Lp(a) distributions, respectively, were 5.6 (95% confidence interval [CI], 5.4-5.9) per 1000 person-years and 4.4 (95% CI, 4.2-4.6) per 1000 person-years. The risk ratio for CHD, adjusted for age and sex only, was 1.16 (95% CI, 1.11-1.22) per 3.5-fold higher usual Lp(a) concentration (ie, per 1 SD), and it was 1.13 (95% CI, 1.09-1.18) following further adjustment for lipids and other conventional risk factors. The corresponding adjusted risk ratios were 1.10 (95% CI, 1.02-1.18) for ischemic stroke, 1.01 (95% CI, 0.98-1.05) for the aggregate of nonvascular mortality, 1.00 (95% CI, 0.97-1.04) for cancer deaths, and 1.00 (95% CI, 0.95-1.06) for nonvascular deaths other than cancer. Under a wide range of circumstances, there are continuous, independent, and modest associations of Lp(a) concentration with risk of CHD and stroke that appear exclusive to vascular outcomes.
登录
查看更多内容
DOI：
10.1375/twin.3.3.152
发表时间：
2000-09-01
期刊：
Twin research : the official journal of the International Society for Twin Studies
影响因子：
--
作者：
Boomsma, D I;Knijff, P;Princen, H M
通讯作者：
Princen, H M
影响因子：
15.9
作者：
BOERWINKLE, E;LEFFERT, CC;HOBBS, HH
通讯作者：
HOBBS, HH
影响因子：
120.7
作者：
Bostom, AG;Cupples, LA;Castelli, WP
通讯作者：
Castelli, WP
影响因子：
5.3
作者：
COLEMAN, MP;KEY, TJA;SANDERS, TAB
通讯作者：
SANDERS, TAB
DOI：
10.1016/s0735-1097(97)00528-7
发表时间：
1998-03-01
影响因子：
24
作者：
Cantin, B;Gagnon, F;Dagenais, GR
通讯作者：
Dagenais, GR