Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger - A prospective study
Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger - A prospective study
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DOI：
10.1001/jama.276.7.544
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发表时间：
1996-08-21
影响因子：
120.7
通讯作者：
Castelli, WP
中科院分区：
文献类型：
--
作者：
Bostom, AG;Cupples, LA;Castelli, WP
客观。-为了确定是否脂蛋白（a）[Lp（a）]升高，检测作为一个下沉的前β-脂蛋白带电泳的新鲜血浆，是一个独立的危险因素，为早发冠心病（CHD）的发展在男性。对Fraketan后代队列的前瞻性研究。在1971年至1975年期间，共有2191名年龄在20至54岁之间的男性接受了心血管疾病检查。55岁以下冠心病（心肌梗死、冠状动脉功能不全、心绞痛或心源性猝死）的发生率。在中位随访15.4年后，有129例CHD事件。相对风险（RR）估计（95%置信区间[Cls]）来自比例风险模型，包括年龄、体重指数和二分风险因素协变量，血浆Lp（a）水平升高，总胆固醇水平6.2 mmol/L（240 mg/dL）或更高，高密度脂蛋白（HDL）水平低于0.9 mmol/L（35 mg/dL）、吸烟、葡萄糖耐量异常和高血压患者的Lp（a）水平升高，RR为1.9（95% CI，1.2-2.9），患病率，11.3%;总胆固醇水平≥ 6.2 mmol/L，RR，1.8（95%CI，1.2-2.7），患病率，14.3%; HDL水平低于0.9 mmol/L，RR，1.8（95% CI，1.2-2.6），患病率，19.2%;吸烟，RR，3.6（95% CI，2.2-5.5），患病率，46.7%;葡萄糖耐受不良，RR，2.7（95%CI，1.4-5.3），患病率，2.6%;高血压，RR，1.2（95%CI，0.8-1.8），患病率，26.3%。血浆Lp（a）升高是男性早发CHD的独立危险因素，其程度和患病率（即归因风险）与总胆固醇水平≥ 6.2 mmol/L（240 mg/dL）或HDL水平低于0.9 mmol/L（35 mg/dL）相当。
Objective.-To establish whether elevated lipoprotein(a) [Lp(a)], detected as a sinking pre-beta-lipoprotein band on electrophoresis of fresh plasma, is an independent risk factor for the development of premature coronary heart disease (CHD) in men.Design and Setting.-Prospective study of the Framingham offspring cohort.Participants.-A total of 2191 men aged 20 to 54 years old who were free of cardiovascular disease when they were examined between 1971 and 1975.Main Outcome Measures.-Incident CHD (myocardial infarction, coronary insufficiency, angina pectoris, or sudden cardiac death) occurring by age 55 years.Results.-After a median follow-up of 15.4 years, there were 129 CHD events. The relative risk (RR) estimates (with 95% confidence intervals [Cls]) for premature CHD derived from a proportional hazards model that included age, body mass index, and the dichotomized risk factor covariables elevated plasma Lp(a) level, total cholesterol level of 6.2 mmol/L (240 mg/dL) or more, high-density lipoprotein (HDL) level less than 0.9 mmol/L (35 mg/dL), smoking, glucose intolerance, and hypertension were as follows: elevated Lp(a) level, RR, 1.9 (95% Cl, 1.2-2.9), prevalence, 11.3%; total cholesterol level of 6.2 mmol/L or more, RR, 1.8 (95% Cl, 1.2-2.7), prevalence, 14.3%; HDL level of less than 0.9 mmol/L, RR, 1.8 (95% Cl, 1.2-2.6), prevalence, 19.2%; smoking, RR, 3.6 (95% Cl, 2.2-5.5), prevalence, 46.7%; glucose intolerance, RR, 2.7 (95% Cl, 1.4-5.3), prevalence, 2.6%; hypertension, RR, 1.2 (95% Cl, 0.8-1.8), prevalence, 26.3%.Conclusions.-Elevated plasma Lp(a) is an independent risk factor for the development of premature CHD in men, comparable in magnitude and prevalence (ie, attributable risk) to a total cholesterol level of 6.2 mmol/L (240 mg/dL) or more, or an HDL level less than 0.9 mmol/L (35 mg/dL).