Lipoprotein(a), hormone replacement therapy, and risk of future cardiovascular events
Lipoprotein(a), hormone replacement therapy, and risk of future cardiovascular events
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DOI：
10.1016/j.jacc.2008.04.009
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发表时间：
2008-07-08
影响因子：
24
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
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作者：
Danik, Jacqueline Suk;Rifai, Nader;Ridker, Paul M.
目的探讨同步激素替代治疗能否改变脂蛋白(A)[Lp(A)]与心血管风险的关系。背景：既往研究表明，激素替代治疗可降低血浆Lp(A)水平，但很少有人评估其是否改变了Lp(A)与心血管疾病(CVD)的关系。方法对27,736名最初健康的女性进行了基线检测，其中12,075人在研究开始时有活跃的HT使用，15,661人没有。根据Lp(A)水平和高血压状态，用COX比例风险模型评估10年来首次发生重大心血管事件(非致命性心肌梗死、非致命性脑血管事件、冠状动脉血运重建或心血管死亡)的风险，并调整潜在的混杂变量。结果正如预期的那样，服用高血压的女性的Lp(A)值较低(中位数为9.4mgdl vs.11.6mgdl，p<；0.0001)。在没有服用羟色胺的女性中，脂蛋白(A)水平最高的五分位数与最低的相比，未来心血管疾病的风险比是1.8%(P趋势和0.0001)，调整了年龄、吸烟、血压、糖尿病、体重指数、总胆固醇、高密度脂蛋白、C反应蛋白和阿司匹林和维生素E的治疗手段后，在服用羟色胺的女性中，几乎没有证据表明与心血管疾病有关(风险比：1.1，P趋势=0.18；Lp(A)五分位数与羟色胺的交互作用p值=0.0009)。这些数据表明，在服用高血压的女性中，Lp(A)的预测作用明显减弱，并可能有助于临床医生对此类患者Lp(A)值的解释。(妇女健康研究；NCT00000479)。
Objectives This study assesses whether the relationship of lipoprotein(a) [Lp(a)] with cardiovascular risk may be modified by concurrent hormone replacement therapy (HT).Background Prior studies indicate that HT decreases plasma levels of Lp(a), but few have been powered to assess whether it modifies the relationship of Lp(a) with cardiovascular disease (CVD).Methods Lipoprotein(a) at baseline was measured among 27,736 initially healthy women, of whom 12,075 indicated active HT use at the time of blood draw at study initiation and 15,661 did not. The risk of first-ever major cardiovascular event (nonfatal myocardial infarction, nonfatal cerebrovascular event, coronary revascularization, or cardiovascular death) over a 10-year period was assessed with Cox proportional hazard models according to Lp(a) levels and HT status and adjusted for potential confounding variables.Results As anticipated, Lp(a) values were lower among women taking HT (median 9.4 mg/dl vs. 11.6 mg/dl, p < 0.0001). In women not taking HT, the hazard ratio of future CVD for the highest Lp(a) quintile compared with the lowest was 1.8 (p trend < 0.0001), after adjusting for age, smoking, blood pressure, diabetes, body mass index, total cholesterol, high-density lipoprotein, C-reactive protein, and treatment arms of aspirin and vitamin E. In contrast, among women taking HT, there was little evidence of association with CVD (hazard ratio: 1.1, p trend = 0.18; interaction p value = 0.0009 between Lp(a) quintiles and HT on incident CVD).Conclusions The relationship of high Lp(a) levels with increased CVD is modified by HT. These data suggest that the predictive utility of Lp(a) is markedly attenuated among women taking HT and may inform clinicians' interpretation of Lp(a) values in such patients. (Women's Health Study [WHS]; NCT00000479).