Apolipoprotein(a) Isoforms and the Risk of Vascular Disease Systematic Review of 40 Studies Involving 58,000 Participants
Apolipoprotein(a) Isoforms and the Risk of Vascular Disease Systematic Review of 40 Studies Involving 58,000 Participants
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DOI：
10.1016/j.jacc.2009.10.080
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发表时间：
2010-05-11
影响因子：
24
通讯作者：
Danesh, John
中科院分区：
文献类型：
--
作者：
Erqou, Sebhat;Thompson, Alexander;Danesh, John
本研究的目的是评估载脂蛋白(a) （apo[a]）亚型与心血管疾病风险的关系。背景：虽然循环脂蛋白(a) （Lp[a]）可能是冠心病（CHD）的一个因果危险因素，但这种关联的程度并不大。载脂蛋白(a)颗粒较小而不是较大的载脂蛋白(a)异构体可能是更强的危险因素。方法整理1970年1月至2009年6月间发表的40篇载脂蛋白(a)同型异构体与冠心病或缺血性卒中风险相关的研究（共涉及11,396例患者和46,938例对照）。结果36项研究使用广泛可比的表型和分析方法来评估载脂蛋白(a)亚型大小。这些研究得出，载脂蛋白(a)亚型较小的个体与较大的个体（对应于kringle IV型2重复约为22或更少，而bbb22重复，或类似于载脂蛋白(a)分子量< 640 kDa与< 640 kDa）发生冠心病的综合相对风险为2.08（95%置信区间[CI]: 1.67至2.58）。这些研究之间存在很大的异质性（I-2 = 85%， 80%至89%），这主要是由于所使用的实验室方法和分析方法的差异。在6项采用可比较表型方法的缺血性卒中研究中，合并相对危险度为2.14（1.85 ~ 2.97）。然而，总体而言，只有3项研究考虑了Lp(a)浓度。结论：载脂蛋白(a)亚型较小的人患冠心病或缺血性中风的风险比蛋白较大的人高约2倍。需要进一步的研究来确定较小的载脂蛋白(a)异构体的影响是否独立于脂蛋白(a)浓度和其他危险因素。[J] journal of nurses training; 2010;5 (1): 1 - 2
Objectives The purpose of this study was to assess the association of apolipoprotein(a) (apo[a]) isoforms with cardiovascular disease risk.Background Although circulating lipoprotein(a) (Lp[a]) is likely to be a causal risk factor in coronary heart disease (CHD), the magnitude of this association is modest. Lipoprotein(a) particles with smaller, rather than larger, apo(a) isoforms may be stronger risk factors.Methods Information was collated from 40 studies published between January 1970 and June 2009 that reported on associations between apo(a) isoforms and risk of CHD or ischemic stroke (involving a total of 11,396 patients and 46,938 controls).Results Thirty-six studies used broadly comparable phenotyping and analytic methods to assess apo(a) isoform size. These studies yielded a combined relative risk for CHD of 2.08 (95% confidence intervals [CI]: 1.67 to 2.58) for individuals with smaller versus larger apo(a) isoforms (corresponding approximately to 22 or fewer kringle IV type 2 repeats vs. >22 repeats or analogously an apo[a] molecular weight of < 640 kDa vs. < 640 kDa). There was substantial heterogeneity among these studies (I-2 = 85%, 80% to 89%), which was mainly explained by differences in the laboratory methods and analytic approaches used. In the 6 studies of ischemic stroke that used comparable phenotypic methods, the combined relative risk was 2.14 (1.85 to 2.97). Overall, however, only 3 studies made allowances for Lp(a) concentration.Conclusions People with smaller apo(a) isoforms have an approximately 2-fold higher risk of CHD or ischemic stroke than those with larger proteins. Further studies are needed to determine whether the impact of smaller apo(a) isoforms is independent from Lp(a) concentration and other risk factors. (J Am Coll Cardiol 2010;55:2160-7) (C) 2010 by the American College of Cardiology Foundation