LDL-C and hs-CRP Jointly Modify the Effect of Lp(a) on 5-Year Death in Patients With Percutaneous Coronary Intervention

IF 2.4 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Clinical Cardiology Pub Date : 2024-10-21 DOI:10.1002/clc.70025
Jiawen Li, Kailun Yan, Pei Zhu, Xiaofang Tang, Yuejin Yang, Runlin Gao, Jinqing Yuan, Xueyan Zhao
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Abstract

Background

Recent studies have suggested that adverse events associated with lipoprotein(a) [Lp(a)] might be modified by low-density lipoprotein cholesterol (LDL-C) or high-sensitivity C-reactive protein (hs-CRP) levels, but whether LDL-C and hs-CRP jointly mediate the outcome of Lp(a) remains unknown in patients with coronary artery disease.

Methods and Results

A prospective study was conducted, enrolling consecutive 10 724 patients with percutaneous coronary intervention (PCI) in 2013. The endpoint event was all-cause death. A total of 10 000 patients with complete baseline data were finally included. During a median follow-up of 5.1 years, Lp(a) ≥ 30 mg/dL was an independent risk factor of all-cause death in the overall population, LDL-C ≥ 70 mg/dL, and hs-CRP ≥ 2 mg/L population, respectively. According to concurrent LDL-C (70 mg/dL) and hs-CRP (2 mg/L) levels, further analysis revealed that when LDL-C < 70 mg/dL regardless of hs-CRP levels, Lp(a) ≥ 30 mg/dL was not an independent predictor of all-cause death. However, when LDL-C ≥ 70 mg/dL, Lp(a) ≥ 30 mg/dL was independently associated with a higher risk of all-cause death in hs-CRP ≥ 2 mg/L (HR: 1.488, 95% CI: 1.059‒2.092), but not in hs-CRP < 2 mg/L (HR: 1.303, 95% CI: 0.914‒1.856).

Conclusion

Among PCI patients, Lp(a)-associated outcome was jointly affected by LDL-C and hs-CRP. As long as LDL-C is well controlled, the adverse effects of increased Lp(a) on cardiovascular risk seem to be weakened, and only when LDL-C and hs-CRP increase at the same time, elevated Lp(a) is associated with poorer long-term outcome.

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低密度脂蛋白胆固醇和 hs-CRP 共同改变了脂蛋白(a)对经皮冠状动脉介入治疗患者 5 年死亡的影响。
背景:最近的研究表明,与脂蛋白(a)[Lp(a)]相关的不良事件可能受低密度脂蛋白胆固醇(LDL-C)或高敏C反应蛋白(hs-CRP)水平的影响,但在冠状动脉疾病患者中,LDL-C和hs-CRP是否共同介导脂蛋白(a)的结果仍是未知数:2013年,一项前瞻性研究连续纳入了10 724名接受经皮冠状动脉介入治疗(PCI)的患者。终点事件为全因死亡。最终共纳入了 1 万名基线数据完整的患者。在中位随访5.1年期间,在总体人群、低密度脂蛋白胆固醇≥70毫克/分升人群和hs-CRP≥2毫克/升人群中,脂蛋白(a)≥30毫克/分升分别是全因死亡的独立危险因素。根据同时出现的 LDL-C(70 毫克/分升)和 hs-CRP(2 毫克/升)水平,进一步分析发现,当 LDL-C在 PCI 患者中,Lp(a)相关预后受到 LDL-C 和 hs-CRP 的共同影响。只要低密度脂蛋白胆固醇得到良好控制,脂蛋白(a)升高对心血管风险的不利影响似乎就会减弱,只有当低密度脂蛋白胆固醇和 hs-CRP 同时升高时,脂蛋白(a)升高才与较差的长期预后相关。
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来源期刊
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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