Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke
Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke
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DOI：
10.1212/wnl.0000000000001938
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发表时间：
2015-11-03
期刊：
影响因子：
9.9
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Lin, Jinxi;Zheng, Hongwei;Wang, Yongjun
目的：探讨短暂性脑缺血发作(TIA)或轻度卒中患者急性期测定的脂蛋白相关磷脂酶A(2)(Lp-PLA(2))与短期血管事件复发风险的关系。方法：我们测定了参加Chance(氯吡格雷)试验的3201名受试者的Lp-PLA(2)活性(Lp-PLA(2)-A)。有短暂性脑缺血发作或轻度中风的参与者在症状出现后24小时内入选，并随机接受单一或双重抗血小板治疗。在目前的分析中，主要结果被定义为缺血性中风、心肌梗死或90天内死亡的综合结果。结果：在3021名参与者中，299人(9.9%)出现了复合终点。人群平均Lp-PLA(2)-A水平为209 59nmol/min/mL(95%可信区间[CI]207-211)。年龄较大、男性和当前吸烟与较高的Lp-PLA2-A水平相关。Lp-PLA2(2)-A与主要终点显著相关(校正危险比1.07，95%可信区间1.01~1.13，每升高30nmol/min/mL)。仅在缺血性中风中也有类似的结果。调整低密度脂蛋白胆固醇后，Lp-LA(2)-A与主要终点的相关性减弱(调整后的危险比为1.04，每增加30nmol/min/m L，95%可信区间为0.97-1.11)。结论：急性期Lp-LA(2)-A水平升高与血管事件复发的短期风险增加有关。
Objective:To determine the association of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke.Methods:We measured Lp-PLA(2) activity (Lp-PLA(2)-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy. In the current analysis, the primary outcome was defined as the composite of ischemic stroke, myocardial infarction, or death within 90 days.Results:The composite endpoint occurred in 299 of 3,021 participants (9.9%). The population average Lp-PLA(2)-A level was 209 59 nmol/min/mL (95% confidence interval [CI] 207-211). Older age, male sex, and current smoking were associated with higher Lp-PLA(2)-A levels. Lp-PLA(2)-A was significantly associated with the primary endpoint (adjusted hazard ratio 1.07, 95% CI 1.01-1.13 for every 30 nmol/min/mL increase). Similar results were seen for ischemic stroke alone. Adjustment for low-density lipoprotein cholesterol attenuated the association between Lp-PLA(2)-A and the primary endpoint (adjusted hazard ratio 1.04, 95% CI 0.97-1.11 for every 30 nmol/min/mL increase).Conclusions:Higher levels of Lp-PLA(2)-A in the acute period are associated with increased short-term risk of recurrent vascular events.