Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: A new prospective cohort study
Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: A new prospective cohort study
复制标题
DOI：
10.1016/j.ijcard.2016.06.069
复制
发表时间：
2016-10-01
影响因子：
3.5
通讯作者：
Laukkanen, Jari A.
中科院分区：
文献类型：
--
作者：
Kunutsor, Setor K.;Khan, Hassan;Laukkanen, Jari A.
背景：脂蛋白(a) [Lp(a)]是心血管结局的一个确定的独立危险因素。然而，Lp(a)与心源性猝死（SCD）风险的关系尚不清楚。在Kuopio缺血性心脏病前瞻性队列研究中，我们的目的是评估Lp(a)与SCD风险的关系，该研究招募了1881名年龄在42-61岁的男性。方法和结果：在基线时评估血浆Lp(a)浓度，隔几年重复测量。中位随访24.7年，记录141例scd。评估了风险比（hr）（95%置信区间[CI]），并对Lp(a)水平的个人变异性进行了校正。年龄调整后loge Lp(a)的回归稀释比为0.84 （95% CI: 0.81-0.88）。脂蛋白(a)水平与SCD风险呈对数线性相关。在对已确定的危险因素进行校正的分析中，每1个标准差（3.56倍）较高基线loge Lp(a)的HR （95% CI）为1.24 （1.05-1.47;P = 0.013）。这在进一步调整酒精摄入量、静息心率、血脂和c反应蛋白1.23 （1.04-1.46；P=0.018）时保持一致。在考虑了突发冠状动脉事件后，hr保持不变，并且在几个相关的临床亚组中没有显著变化。在SCD风险预测模型中加入Lp(a)并没有显著提高既定危险因素之外的风险区分，但使连续净重分类提高了30.2% （1.1 ~ 59.2%，P=0.042）。结论：现有证据显示Lp(a)水平与SCD风险之间存在持续且独立的关联。需要进一步的研究来重复这些发现。2016爱思唯尔爱尔兰有限公司版权所有。
Background: Lipoprotein(a) [Lp(a)] is an established and independent risk factor for cardiovascular outcomes. However, the relationship of Lp(a) with risk of sudden cardiac death (SCD) is unknown. We aimed to assess the association of Lp(a) with risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of 1881 men aged 42-61 years at recruitment.Methods and results: Plasma Lp(a) concentration was assessed at baseline and repeat measurements made several years apart. After a median follow-up of 24.7 years, 141 SCDs were recorded. Hazard ratios (HRs) (95% confidence intervals [CI]) were assessed and were corrected for within-person variability in Lp(a) levels. The regression dilution ratio of loge Lp(a) adjusted for age was 0.84 (95% CI: 0.81-0.88). Lipoprotein(a) levels were log-linearly associated with risk of SCD. In analyses adjusted for established risk factors, the HR (95% CI) for SCD per 1 standard deviation (3.56-fold) higher baseline loge Lp(a) was 1.24 (1.05-1.47; P = 0.013). This remained consistent on further adjustment for alcohol consumption, resting heart rate, lipids, and C-reactive protein 1.23 (1.04-1.46; P=0.018). HRs remained unchanged after accounting for incident coronary events and did not vary importantly in several relevant clinical subgroups. Adding Lp(a) to a SCD risk prediction model did not significantly improve risk discrimination beyond established risk factors, but improved the continuous net reclassification 30.2% (1.1 to 59.2%, P=0.042).Conclusions: Available evidence shows a continuous and independent association between Lp(a) levels and risk of SCD. Further research is needed to replicate these findings. (C) 2016 Elsevier Ireland Ltd. All rights reserved.