The prevalence, patients' characteristics, and hyper-Lp(a)-emia risk factors in the Polish population. The first results from the PMMHRI-Lp(a) Registry

IF 5.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Bożena Sosnowska , Joanna Lewek , Weronika Adach , Karina Mierczak , Agata Bielecka-Dąbrowa , Konrad Szosland , Arkadiusz Zygmunt , Jan Dąbrowski , Maciej Banach
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引用次数: 0

Abstract

Background

The knowledge on the prevalence of elevated lipoprotein(a) (Lp(a)), patients' characteristics, and nongenetic risk factors is scarce in some regions including Poland, the largest Central and Eastern European country. Thus, we aimed to present the results from the Lp(a) registry established in Poland's 2nd largest, supra-regional hospital - the Polish Mother's Memorial Hospital Research Institute (PMMHRI).

Methods

The PMMHRI-Lp(a)-Registry was established in January 2022. Since that time all consecutive patients of the Departments of Cardiology, Endocrinology, and outpatient cardiology, diabetology and metabolic clinics have been included. The indications for Lp(a) measurement in the registry are based on the 2021 Polish Lipid Guidelines and new Polish recommendations on the management of elevated Lp(a) (2024). Lp(a) was determined using Sentinel's Lp(a) Ultra, an Immunoturbidimetric quantitative test (Sentinel, Milan, Italy), and the results are presented in mg/dL.

Results

511 patients were included in the registry between Jan 2022 and 15th May 2024. The mean age of patients was 48.21 years. Female patients represented 53.42 % of the population. Elevated Lp(a) levels above 30 and 50 mg/dL were detected in 142 (27.79 %), and 101 (19.8 %) patients, respectively. The mean Lp(a) level was 30.45 ± 42.50 mg/dL, with no significant sex differences [mean for men: 28.80 mg/dL; women: 31.89 mg/dL]. There were also no significant differences between those with and without: coronary artery disease (CAD), dyslipidemia, stroke, heart failure, cancer, diabetes, chronic kidney disease, and thyroid disease. The significant Lp(a) level difference was observed in those with a history of myocardial infarction (MI) vs those without (51.47 ± 55.16 vs 28.09 ± 37.51 mg/dL, p < 0.001). However, when we divided those with premature vs no premature MI, no significant difference in Lp(a) level was observed (51.43 ± 57.82 vs 51.52 ± 53.18 mg/dL, p = 0.95). Lipid-lowering therapy (LLT) at baseline did not significantly affect Lp(a) level, with only significant differences for the highest doses of rosuvastatin (p < 0.05) and in those treated with ezetimibe (as a part of the combination therapy; 44.73 ± 54.94 vs 26.84 ± 37.11 mg/dL, p < 0.001). For selected patients (n = 43; 8.42 %) with at least two Lp(a) measurements (mean time distance: 7 ± 5 months, range 1–20 months) we did not observe statistically significant visit-to-visit variability (mean difference: 3.25 mg/dL; r = 0.079, p = 0.616). While dividing the whole population into those with Lp(a) ≤30 mg/dL and > 30 mg/dL, the only hyper-Lp(a)-emia prevalence differences were seen for FH diagnosis (12.88 vs 21.43; p = 0.017), MI prevalence (6.52 vs 16.90 %; p < 0.001), thyroid disease diagnosis (18.14 vs 26.76 %; p = 0.033) and ezetimibe treatment (18.58 vs 30.77 %, p = 0.036). A similar pattern was observed while dividing the whole population on those with Lp(a) ≤50 mg/dL (125 nmol/L) and > 50 mg/dL (125 nmol/L) except for no statistical difference for thyroid disease.

Conclusions

These results strongly emphasize that Lp(a) should be measured commonly, as its high level is highly prevalent (even every 3rd patient) in patients at cardiovascular disease (CVD) risk in primary and secondary prevention, requiring risk re-stratification and optimization of the treatment. This is especially important in the regions that characterize baseline high CVD risk, which refers to most CEE countries, including Poland.
波兰人口中高脂蛋白(a)血症的发病率、患者特征和高脂蛋白(a)血症风险因素。PMMHRI-Lp(a)登记的首批结果。
背景:在一些地区,包括中东欧最大的国家波兰,有关脂蛋白(a)(Lp(a))升高的患病率、患者特征和非遗传风险因素的知识非常匮乏。因此,我们旨在介绍在波兰第二大地区级医院--波兰母亲纪念医院研究所(PMMHRI)建立的脂蛋白(a)登记册的结果:波兰母亲纪念医院研究所脂蛋白(a)登记处成立于2022年1月。方法:PMMHRI-Lp(a)登记处成立于2022年1月,自此,所有连续就诊于心脏病科、内分泌科、心脏病门诊、糖尿病门诊和代谢门诊的患者都被纳入其中。登记册中的脂蛋白(a)测量指征是根据 2021 年《波兰血脂指南》和波兰关于脂蛋白(a)升高管理的新建议(2024 年)制定的。脂蛋白(a)使用 Sentinel's Lp(a) Ultra 免疫比浊定量检测仪(意大利米兰 Sentinel 公司)进行测定,结果以毫克/分升为单位:2022年1月至2024年5月15日期间,511名患者被纳入登记册。患者平均年龄为 48.21 岁。女性患者占总人数的 53.42%。分别有 142 名(27.79%)和 101 名(19.8%)患者的脂蛋白(a)水平高于 30 毫克/分升和 50 毫克/分升。脂蛋白(a)的平均水平为 30.45 ± 42.50 毫克/分升,无明显性别差异[男性平均:28.80 毫克/分升;女性:31.89 毫克/分升]。患有和未患有冠状动脉疾病(CAD)、血脂异常、中风、心力衰竭、癌症、糖尿病、慢性肾病和甲状腺疾病的人之间也没有明显差异。有心肌梗死(MI)病史者与无心肌梗死病史者的 Lp(a)水平差异明显(51.47 ± 55.16 vs 28.09 ± 37.51 mg/dL,p 30 mg/dL,唯一的高 Lp(a)血症患病率差异见于 FH 诊断(12.88 vs 21.43; p = 0.017)、心肌梗死患病率(6.52 vs 16.90 %; p 50 mg/dL (125 nmol/L),但甲状腺疾病无统计学差异:这些结果有力地强调了应普遍测量脂蛋白(a),因为在一级和二级预防的心血管疾病(CVD)风险患者中,脂蛋白(a)的高水平非常普遍(甚至每三个患者中就有一个),需要重新进行风险分级和优化治疗。这对于心血管疾病高风险地区尤为重要,这些地区包括波兰在内的大多数中欧和东欧国家。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Progress in cardiovascular diseases
Progress in cardiovascular diseases 医学-心血管系统
CiteScore
10.90
自引率
6.60%
发文量
98
审稿时长
7 days
期刊介绍: Progress in Cardiovascular Diseases provides comprehensive coverage of a single topic related to heart and circulatory disorders in each issue. Some issues include special articles, definitive reviews that capture the state of the art in the management of particular clinical problems in cardiology.
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