Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis.
Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis.
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阿司匹林与脂蛋白升高个体的心血管风险(a)：动脉粥样硬化的多种族研究。
DOI：
10.1161/jaha.123.033562
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发表时间：
2024
影响因子：
5.4
通讯作者：
Tsimikas,Sotirios
中科院分区：
文献类型：
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作者：
Bhatia,HarpreetS;Trainor,Patrick;Carlisle,Samantha;Tsai,MichaelY;Criqui,MichaelH;DeFilippis,Andrew;Tsimikas,Sotirios
背景目前缺乏降低脂蛋白（a）升高人群心血管疾病（CVD）风险的有效治疗方法，尤其是一级预防。由于脂蛋白（a）与血栓形成的潜在关联，我们评估了使用阿司匹林与脂蛋白（a）升高的人的心血管事件之间的关系。方法和结果我们使用了来自梅萨（多种族动脉粥样硬化研究）的数据，这是一项前瞻性队列研究，研究对象为无基线心血管疾病的个体。由于适应症的潜在混杂，我们使用基于CVD风险因素的倾向评分将阿司匹林使用者与非使用者进行匹配。然后，我们使用校正了CVD危险因素的考克斯比例风险模型，按照基线脂蛋白（a）水平（阈值为50 mg/dL）分层，评估阿司匹林使用与冠心病（CHD）事件（CHD死亡、非致死性心肌梗死）之间的相关性。在倾向匹配后，研究队列包括2183名参与者，包括1234名（57%）基线阿司匹林使用者和423名（19%）脂蛋白（a）>50 mg/dL。脂蛋白（a）>50 mg/dL的受试者有更高的心血管危险因素负担，更频繁地使用阿司匹林（61.7%vs55.3%，P =0.02），更高的冠心病事件发生率（13.7%vs8.9%，P <0.01）。在脂蛋白（a）升高的患者中，阿司匹林与冠心病事件的显著减少相关（风险比，0.54 [95%CI，0.32-0.94];P=0.03）。脂蛋白（a）>50 mg/dL且服用阿司匹林者与脂蛋白（a）≤50 mg/dL者CHD风险相似，无论是否服用阿司匹林。这项观察性倾向匹配研究的结果需要在阿司匹林使用随机化的研究中确认。
BackgroundEffective therapies for reducing cardiovascular disease (CVD) risk in people with elevated lipoprotein(a) are lacking, especially for primary prevention. Because of the potential association of lipoprotein(a) with thrombosis, we evaluated the relationship between aspirin use and CVD events in people with elevated lipoprotein(a).Methods and ResultsWe used data from the MESA (Multi‐Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of baseline cardiovascular disease. Due to potential confounding by indication, we matched aspirin users to nonusers using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) stratified by baseline lipoprotein(a) level (threshold of 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. After propensity matching, the study cohort included 2183 participants, including 1234 (57%) with baseline aspirin use and 423 (19%) with lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had a higher burden of CVD risk factors, more frequent aspirin use (61.7% versus 55.3%,P=0.02), and higher rate of incident CHD events (13.7% versus 8.9%,P<0.01). Aspirin was associated with a significant reduction in CHD events among those with elevated lipoprotein(a) (hazard ratio, 0.54 [95% CI, 0.32–0.94];P=0.03). Those with lipoprotein(a) >50 mg/dL and aspirin use had similar CHD risk as those with lipoprotein(a) ≤50 mg/dL regardless of aspirin use.ConclusionsAspirin use was associated with a significantly lower risk for CHD events in participants with lipoprotein(a) >50 mg/dL without baseline CVD. The results of this observational propensity‐matched study require confirmation in studies with randomization of aspirin use.