临床病情稳定患者脂蛋白（a）的时间变异性：对心血管风险评估的影响。

IF 2.6 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medicina Clinica Pub Date : 2024-11-15 DOI:10.1016/j.medcli.2024.05.023

Maria G. Matta , Laura Schreier , Augusto Lavalle-Cobo , Sebastian Garcia-Zamora , Agustina Ferraresi , Angeles Madsen , Sofia Bellini , Guadalupe Ramos , Paula Roubicek , Pablo Corral

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引用次数: 0

摘要

目的：脂蛋白（a）[Lp(a)]是心血管疾病的重要危险因素，但在常规临床评估中却经常被忽视。由于脂蛋白（a）主要是由基因决定的风险因素，传统的建议是一生评估一次其水平，因为脂蛋白（a）随时间的变化被认为是最小的。本研究旨在评估临床病情稳定的患者体内脂蛋白（a）的潜在变异性，并调查导致脂蛋白（a）水平不稳定的因素：方法：我们对在血脂诊所就诊的成年患者样本进行了回顾性分析。参与者至少进行过两次脂蛋白（a）测量，测量间隔至少为四个月。脂蛋白（a）测量采用免疫比浊法进行。脂蛋白（a）值的变异性按与基线相比的变化百分比计算，参与者的脂蛋白（a）水平变化超过 25% 即为变异性过高。此外，还对其他临床和生化变量进行了评估：结果：61 名参与者共进行了 171 次脂蛋白（a）测定。34%的人的变异率达到或超过 25%（高变异）。男性的变异性略高于女性。在高变异患者中观察到脂蛋白（a）类别的变化，一些参与者的脂蛋白（a）类别有所增加，而另一些参与者的脂蛋白（a）类别则有所减少。所有存在高变异水平的女性都有绝经现象：我们的研究表明，应重新考虑依赖单次脂蛋白（a）测量来评估心血管风险的做法。重复测量，尤其是对边缘病例进行重复测量，可能会有所裨益。

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Temporal variability of Lp(a) in clinically stable patients: Implications for cardiovascular risk assessment

Objectives

Lipoprotein(a) [Lp(a)] is a significant risk factor for cardiovascular disease, yet it is often overlooked in routine clinical assessments. As a primarily genetically determined risk factor, the traditional recommendation is to assess its level once in a lifetime, as the variability of Lp(a) over time is considered to be minimal. This study aims to evaluate the potential variability of Lp(a) in clinically stable patients and investigate factors contributing to the lack of stable levels.

Methods

A retrospective analysis was conducted on a sample of adult patients attending a lipid clinic. Participants with at least two Lp(a) measurements taken with a minimum interval of four months were included. Lp(a) measurements were performed using the immunoturbidimetric assay. Variability in Lp(a) values was calculated as a percentage change from baseline, with participants exceeding a 25% change classified as having hypervariable Lp(a) levels. Additional clinical and biochemical variables were assessed.

Results

61 participants with 171 Lp(a) determinations were included. Thirty-four percent exhibited a variability of 25% or higher (hypervariable). Men showed slightly greater variability than women. Changes in Lp(a) categories were observed among hypervariable patients, with some participants experiencing an increase while others showed a decrease. Menopause was present in all the women with hypervariable levels.

Conclusion

Our study suggests reconsidering the reliance on a single Lp(a) measurement for assessing cardiovascular risk. Repeat measurements, particularly in borderline cases, may be beneficial.

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来源期刊

Medicina Clinica 医学-医学：内科

CiteScore

3.10

自引率

5.10%

发文量

295

审稿时长

22 days

期刊介绍： Medicina Clínica, fundada en 1943, es una publicación quincenal dedicada a la promoción de la investigación y de la práctica clínica entre los especialistas de la medicina interna, así como otras especialidades. Son características fundamentales de esta publicación el rigor científico y metodológico de sus artículos, la actualidad de los temas y, sobre todo, su sentido práctico, buscando siempre que la información sea de la mayor utilidad en la práctica clínica.