Lipoprotein(a) levels and risk of future coronary heart disease
Lipoprotein(a) levels and risk of future coronary heart disease
复制标题
DOI：
10.1001/archinte.168.6.598
复制
发表时间：
2008-03-24
影响因子：
--
通讯作者：
Gudnason, Vilmundur
中科院分区：
文献类型：
--
作者：
Bennet, Anna;Di Angelantonio, Ernanuele;Gudnason, Vilmundur
背景资料：需要大规模的前瞻性数据来确定脂蛋白（a）（Lp[a]）和冠心病（CHD）风险之间的关联是否独立于已建立的风险因素，以描述这种关系的形式，并量化相关亚组中的关联。方法：从2047名首次接受治疗的患者的基线样本中测量Lp（a）水平，在研究期间和雷克雅未克研究的3921名对照参与者中，（n = 18569），以及在相隔12年的372名参与者中获得的配对样本中量化人内波动。基线Lp（a）水平与已知的心血管危险因素（如年龄、性别、总胆固醇水平和血压）几乎没有相关性。Lp（a）值在十年之间高度一致，回归稀释比（以对数标尺计算）为0.92（95%置信区间，0.85-0.99）。在校正了几个已确定的危险因素（年龄、性别、吸烟状况、血压、总胆固醇、甘油三酯水平、糖尿病和体重指数）后，CHD的比值比不变，在基线Lp（a）水平的极端三分之一的比较中为1.60（95%置信区间，1.38-1.85）。比值比随着Lp（a）水平的增加而逐渐升高，并且几个个体或研究水平的特征没有实质性变化。结论：在广泛的个体中，Lp（a）水平与未来冠心病风险之间存在独立、持续的相关性。Lp（a）水平在个体中多年来高度稳定，与已知的风险因素仅弱相关。进一步评估其在冠心病预防中的可能作用是必要的。
Background: Large-scale prospective data are needed to determine whether associations between lipoprotein(a) (Lp[a]) and coronary heart disease (CHD) risk are independent of established risk factors, to characterize the shape of this relationship, and to quantify associations in relevant subgroups.Methods: Levels of Lp(a) were measured in samples obtained at baseline from 2047 patients who had first-ever nonfatal myocardial infarction or who died of CHD during the study and from 3921 control participants in the Reykjavik Study (n = 18 569), as well as in paired samples obtained 12 years apart from 372 participants to quantify within-person fluctuations.Results: Baseline Lp(a) levels had little or no correlation with known cardiovascular risk factors, such as age, sex, total cholesterol level, and blood pressure. The Lp(a) values were highly consistent from decade to decade, with a regression dilution ratio (calculated on the log scale) of 0.92 (95% confidence interval, 0.85-0.99). The odds ratio for CHD, unaltered after adjustment for several established risk factors (age, sex, smoking status, blood pressure, total cholesterol, triglycerides level, diabetes mellitus, and body mass index), was 1.60 (95% confidence interval, 1.38-1.85) in a comparison of extreme thirds of baseline Lp(a) levels. Odds ratios were progressively higher with increasing Lp(a) levels and did not vary materially by several individual- or study-level characteristics.Conclusions: There are independent, continuous associations between Lp(a) levels and risk of future CHD in a broad range of individuals. Levels of Lp(a) are highly stable within individuals across many years and are only weakly correlated with known risk factors. Further assessment of their possible role in CHD prevention is warranted.