Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population
Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population
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DOI：
10.1161/circulationaha.107.715698
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发表时间：
2008-01-15
期刊：
影响因子：
37.8
通讯作者：
Nordestgaard, Borge G.
中科院分区：
文献类型：
--
作者：
Kamstrup, Pia R.;Benn, Marianne;Nordestgaard, Borge G.
背景：在一些但并非所有研究中，脂蛋白（a）水平升高与心肌梗死（MI）相关。先前研究的局限性包括缺乏极端脂蛋白（a）水平的风险估计、长期冷冻样本的测量、没有对回归稀释偏差进行校正以及缺乏一般人群的绝对风险估计。我们测试了极端脂蛋白 (a) 水平可预测一般人群 MI 的假设，在采样后不久测量水平，校正回归稀释偏差，并计算风险比和绝对风险估计。方法和结果 - 我们在哥本哈根城市心脏研究中检查了一般人群中的 9330 名男性和女性。在 10 年的随访中，498 名参与者出现了 MI。在女性中，脂蛋白(a)水平升高的多因素调整后的心肌梗死风险比为：5至29 mg/dL（第22至66个百分位）为1.1（95% CI，0.6至1.9），30至84 mg/dL（第67至89个百分位）为1.7（1.0至3.1），2.6（1.2至89个百分位）。 85 至 119 mg/dL（第 90 至 95 个百分位）为 5.9），>= 120 mg/dL（> 95 个百分位）为 3.6（1.7 至 7.7），而 < 5 mg/dL（< 22 个百分位）则为 3.6（1.7 至 7.7）。男性的等效值为 1.5（0.9 至 2.3）、1.6（1.0 至 2.6）、2.6（1.2 至 5.5）和 3.7（1.7 至 8.0）。对于年龄 > 60 岁、脂蛋白 (a) 水平 < 5 和 >= 120 mg/dL 的吸烟、高血压女性，MI 的 10 年绝对风险分别为 10% 和 20%。男性的等效值为 19% 和 35%。 结论 - 我们观察到随着脂蛋白 (a) 水平的增加，心肌梗死的风险逐步增加，但没有证据表明存在阈值效应。极端脂蛋白(a) 水平预示普通人群患心肌梗死的风险会增加 3 至 4 倍，而高危女性和男性的 10 年绝对风险将分别增加 20% 和 35%。
Background-Elevated lipoprotein(a) levels are associated with myocardial infarction (MI) in some but not all studies. Limitations of previous studies include lack of risk estimates for extreme lipoprotein(a) levels, measurements in long- term frozen samples, no correction for regression dilution bias, and lack of absolute risk estimates in the general population. We tested the hypothesis that extreme lipoprotein(a) levels predict MI in the general population, measuring levels shortly after sampling, correcting for regression dilution bias, and calculating hazard ratios and absolute risk estimates.Methods and Results-We examined 9330 men and women from the general population in the Copenhagen City Heart Study. During 10 years of follow-up, 498 participants developed MI. In women, multifactorially adjusted hazard ratios for MI for elevated lipoprotein(a) levels were 1.1 (95% CI, 0.6 to 1.9) for 5 to 29 mg/dL (22nd to 66th percentile), 1.7 (1.0 to 3.1) for 30 to 84 mg/dL (67th to 89th percentile), 2.6 (1.2 to 5.9) for 85 to 119 mg/ dL (90th to 95th percentile), and 3.6 (1.7 to 7.7) for >= 120 mg/ dL (> 95th percentile) versus levels < 5 mg/ dL (< 22nd percentile). Equivalent values in men were 1.5 (0.9 to 2.3), 1.6 (1.0 to 2.6), 2.6 (1.2 to 5.5), and 3.7 (1.7 to 8.0). Absolute 10- year risks of MI were 10% and 20% in smoking, hypertensive women aged > 60 years with lipoprotein(a) levels of < 5 and >= 120 mg/dL, respectively. Equivalent values in men were 19% and 35%.Conclusions-We observed a stepwise increase in risk of MI with increasing levels of lipoprotein(a), with no evidence of a threshold effect. Extreme lipoprotein(a) levels predict a 3- to 4-fold increase in risk of MI in the general population and absolute 10-year risks of 20% and 35% in high-risk women and men.