Abnormal Lipoprotein(a) Levels Predict Coronary Artery Calcification in Southeast Asians but Not in Caucasians: Use of Noninvasive Imaging for Evaluation of an Emerging Risk Factor
Abnormal Lipoprotein(a) Levels Predict Coronary Artery Calcification in Southeast Asians but Not in Caucasians: Use of Noninvasive Imaging for Evaluation of an Emerging Risk Factor
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DOI：
10.1007/s12265-011-9273-3
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发表时间：
2011-08-01
影响因子：
3.4
通讯作者：
Voros, Szilard
中科院分区：
文献类型：
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作者：
Sharma, Abhinav;Kasim, Manoefris;Voros, Szilard
亚临床动脉粥样硬化可以通过冠状动脉钙（CAC）评分来量化。由于其对动脉粥样硬化的高度特异性，CAC是评估新兴风险标志物的出色表型工具。脂蛋白（a）[Lp（a）]由于存在载脂蛋白B而致动脉粥样硬化，并可能通过其载脂蛋白（a）组分形成血栓。脂蛋白（a）与高加索人的心血管事件有关;然而，其与不同种族动脉粥样硬化的联系尚不清楚。我们评估了脂蛋白（a）质量预测东南亚人和高加索人亚临床动脉粥样硬化的能力，通过CAC测量。在美国的103例连续患者和印度尼西亚雅加达的104例连续患者中进行了传统的血脂测量、Lp（a）测量和64层多探测器计算机断层扫描CAC。东南亚人和高加索人的阳性CAC比例和中位CAC分别为61.5%和63.1%，23.5（四分位距，0-270）和13（四分位距，0-388）。与高加索人相比，东南亚人Lp（a）水平升高的比例显著更高（51.0% vs. 29.2%; p = 0.005）。在东南亚人中，Lp（a）仍然是CAC的独立预测因子，比值比为4.97（95%置信区间，1.56-15.88; p < 0.0001），但在高加索人中并非如此。受试者工作特征分析显示，当在东南亚人的预测模型中包括Lp（a）时，曲线下面积从0.81改善至0.86（p = 0.05）。这意味着7%的东南亚人重新分类为正确的CAC状态。Lp（a）测量可能在东南亚人的风险分层中发挥作用。当考虑在风险评估中使用Lp（a）测量时，应考虑种族差异。
Subclinical atherosclerosis can be quantified by coronary artery calcium (CAC) scoring. Due to its high specificity for atherosclerosis, CAC is an excellent phenotypic tool for the evaluation of emerging risk markers. Lipoprotein(a) [Lp(a)] is atherogenic due to the presence of apoB and may be thrombogenic through its apo(a) component. Lp(a) has been linked to cardiovascular events in Caucasians; however, its link to atherosclerosis in various ethnicities remains unclear. We evaluated the ability of Lp(a) mass to predict subclinical atherosclerosis in Southeast Asians and Caucasians, as measured by CAC. Traditional lipid measurements, Lp(a) measurements, and CAC by 64-slice multidetector computed tomography was performed in 103 consecutive patients in the USA and in 104 consecutive patients in Jakarta, Indonesia. Proportion of positive CAC and median CAC in Southeast Asians and in Caucasians was 61.5% and 63.1%, and 23.5 (interquartile range, 0-270) and 13 (interquartile range, 0-388), respectively. Significantly higher proportion of Southeast Asians had elevated Lp(a) levels, compared to Caucasians (51.0% vs. 29.2%; p = 0.005). In Southeast Asians, Lp(a) remained an independent predictor of CAC with an odds ratio of 4.97 (95% confidence interval, 1.56-15.88; p < 0.0001), but not in Caucasians. Receiver operating characteristic analysis showed an improvement in area under the curve from 0.81 to 0.86 (p = 0.05) when including Lp(a) in the predictive model in Southeast Asians. This translated to 7% of Southeast Asians reclassified to correct CAC status. Lp(a) measurements may have a role in risk stratification of Southeast Asians. Ethnic variation should be taken into account when considering the use of Lp(a) measurements in risk assessment.