不同糖尿病状态下脂蛋白(a)与动脉粥样硬化之间的关系:一项针对中国人群的横断面研究。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2025-02-28 Epub Date: 2025-02-25 DOI:10.21037/cdt-24-410
Guoli Yang, Yue Luo, Kanghua Ma, Bao Yang, Ping Tang, Min Zhang, Qian Dong, Min Mao
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引用次数: 0

摘要

背景:脂蛋白(a) [Lp(a)]水平和糖尿病状态已被认为是动脉粥样硬化的危险因素。然而,尚无关于动脉粥样硬化的研究将这两个指标结合起来。本研究旨在评估Lp(a)水平、糖尿病状态及其对亚临床动脉粥样硬化的综合影响之间的关系。方法:本横断面研究纳入了2018年6月至2022年2月在重庆医科大学第一附属医院首次出现胸痛的患者。所有参与者都接受了冠状动脉计算机断层血管造影(CCTA)和颈动脉超声来评估亚临床动脉粥样硬化。使用Logistic回归分析来检查Lp(a)水平与糖尿病状态(单独或联合)与冠状动脉钙(CAC)和颈动脉病变的关系。结果:912例患者中,473例(51.9%)有CAC, 637例(69.8%)有颈动脉病变。在调整混杂变量后,升高的Lp(a)水平与CAC[比值比(OR) 1.51, 95%可信区间(CI): 1.02-2.24, P=0.040]和颈动脉病变(OR 1.77, 95% CI: 1.10-2.86, P=0.02)相关具有统计学意义。合并糖尿病情况后,糖尿病(DM)组几乎所有Lp(a)水平均与CAC及CAC评分类别(CAC评分:0.1-99.9,100-399.9,≥400)显著相关。在该组中,Lp(a)水平为bb0 ~ 300 mg/L的患者发生CAC的风险最高,CAC评分类别也最严重。在DM患者中,低Lp(a)水平组CAC的患病率和严重程度比中Lp(a)水平组更明显。此外,在仅患有糖尿病的患者中,Lp(a)水平升高与颈动脉病变相关(OR 3.38, 95% CI: 1.24-9.20;P=0.02),颈动脉内膜-中膜厚度增加(cIMT;或3.67,95% ci: 1.10-12.30;P=0.04),稳定/易损颈动脉斑块(OR 3.39, 95% CI: 1.09-10.55;P = 0.04;或3.21,95% ci: 1.07-9.65;P = 0.04)。然而,前驱糖尿病与CAC或颈动脉病变之间没有显著差异。结论:在胸痛和无心血管疾病(CVD)的糖尿病患者中,Lp(a)水平与亚临床动脉粥样硬化显著相关,并与糖尿病有协同作用。值得注意的是,糖尿病患者低Lp(a)水平可能导致额外的亚临床动脉粥样硬化风险,而糖尿病前期没有显示出相同的关联。因此,这些发现强调了基于Lp(a)水平和糖尿病状态制定亚临床动脉粥样硬化早期预防策略的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association between lipoprotein(a) and atherosclerosis with different diabetic status: a cross-sectional study in a Chinese population.

Background: Lipoprotein(a) [Lp(a)] levels and diabetic status have been recognized as risk factors for atherosclerosis. However, no studies on atherosclerosis have integrated these two indicators. This study aimed to evaluate the relationship between Lp(a) levels, diabetic status, and their combined effects on subclinical atherosclerosis.

Methods: This cross-sectional study included patients presenting with a first episode of chest pain at the First Affiliated Hospital of Chongqing Medical University from June 2018 to February 2022. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound to evaluate subclinical atherosclerosis. Logistic regression analysis was used to examine the associations of Lp(a) levels and diabetic status-both individually and in combination-with coronary artery calcium (CAC) and carotid arteriopathy.

Results: Among 912 patients, 473 (51.9%) had CAC and 637 (69.8%) had carotid arteriopathy. After adjusting the confounding variables, elevated Lp(a) levels associated with CAC [odds ratio (OR) 1.51, 95% confidence interval (CI): 1.02-2.24, P=0.040] and carotid arteriopathy (OR 1.77, 95% CI: 1.10-2.86, P=0.02) were statistically significant. After combining diabetic status, almost all Lp(a) levels were significantly associated with CAC and CAC score categories (CAC scores: 0.1-99.9, 100-399.9, ≥400) in the diabetes mellitus (DM) group. In this group, the highest risk for CAC and the most severe CAC score categories were observed in patients with Lp(a) levels of >300 mg/L. Among patients with DM, in the lower Lp(a) level group, the prevalence and severity of CAC were more pronounced than those in the medium Lp(a) level group. Additionally, in patients with DM only, elevated Lp(a) levels were associated with carotid arteriopathy (OR 3.38, 95% CI: 1.24-9.20; P=0.02), increased carotid intima-media thickness (cIMT; OR 3.67, 95% CI: 1.10-12.30; P=0.04), and stable/vulnerable carotid plaque (OR 3.39, 95% CI: 1.09-10.55; P=0.04; OR 3.21, 95% CI: 1.07-9.65; P=0.04). However, there were no significant differences between prediabetes and CAC or carotid arteriopathy.

Conclusions: In patients with chest pain and DM without cardiovascular disease (CVD), Lp(a) level was significantly associated with subclinical atherosclerosis and had a synergistic effect with DM. Notably, lower Lp(a) levels in patients with DM may lead to an additional subclinical atherosclerosis risk, whereas prediabetes does not show the same association. Therefore, these findings highlight the importance of formulating early preventive strategies for subclinical atherosclerosis based on Lp(a) levels and diabetic status.

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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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