脂蛋白(a)与心血管疾病风险中常见心血管危险因素的相互作用：基于英国生物银行的证据

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-05-22 DOI:10.1016/j.ajpc.2025.101008

Linjun Ao , Raymond Noordam , J Wouter Jukema , Diana van Heemst , Ko Willems van Dijk

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引用次数: 0

摘要

背景：虽然脂蛋白(a) （Lp(a)）与心血管疾病相关，但尚不清楚在存在其他伴随危险因素时相关风险是否相似。在这里，我们旨在研究Lp(a)和常见心血管危险因素在冠状动脉疾病（CAD）、钙化主动脉瓣狭窄（CAVS）和缺血性脑卒中（IS）中的相互作用。方法：我们纳入了来自UK Biobank的127,958名无血缘关系的欧洲血统参与者（54.7%为女性），他们有Lp(a)数据，没有CAD、CAVS和IS的基线病史。采用多变量校正Cox比例风险相互作用模型，研究Lp(a)与预后的相关性是否因总胆固醇（total -c）、低密度脂蛋白-胆固醇（LDL-C）、甘油三酯（TG）及其他心血管危险因素的水平而变化。结果：较高的Lp(a)水平与CAD、CAVS和IS的高风险相关。Lp(a)每增加10 mg/dL， CAD、CAVS和IS的风险比[95%可信区间]分别为1.05[1.04,1.06]、1.06[1.04,1.09]和1.01[0.99,1.03]。对于CAD，观察到Lp(a)与Total-C (Pinteraction=0.001), LDL-C （Pinteraction=4e-4）和TG （Pinteraction=0.026）之间的相互作用。更详细地说，在Total-C、LDL-C和TG的最高四分位数中，Lp(a)≥50 mg/dL的参与者在CAD中显示出加性相互作用的证据，相互作用导致的相对超额风险（rei）分别为0.42（0.17,0.67）、0.44（0.18,0.71）和0.39（0.12,0.67）。结论：slp (a)相关的冠心病风险似乎特别影响Total-C、LDL-C和TG水平高于临床指南阈值的患者。

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The interactions of Lipoprotein(a) with common cardiovascular risk factors in cardiovascular disease risk: evidence based on the UK Biobank

Background

: Although Lipoprotein(a) (Lp(a)) is associated with cardiovascular disease, it is unclear whether the associated risk is similar in the presence of other concomitant risk factors. Here, we aimed to investigate the interactions between Lp(a) and common cardiovascular risk factors on coronary artery disease (CAD), calcific aortic valve stenosis (CAVS) and ischemic stroke (IS).

Methods

: We included 127,958 unrelated European-ancestry participants from UK Biobank (54.7 % women) with data available on Lp(a) and without a baseline history of CAD, CAVS and IS. Multivariable-adjusted Cox proportional hazards interaction models were used to study whether the associations of Lp(a) with outcomes varied based on the level of total cholesterol (Total-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG) and other cardiovascular risk factors.

Results

: Higher Lp(a) levels were associated with higher risks of CAD, CAVS and IS. Per 10 mg/dL increase in Lp(a), hazard ratios [95 % confidence interval] were 1.05 [1.04, 1.06], 1.06 [1.04, 1.09], and 1.01 [0.99, 1.03] for CAD, CAVS and IS, respectively. For CAD, interactions were observed between Lp(a) and Total-C (P_interaction=0.001), LDL-C (P_interaction=4e-4) and TG (P_interaction=0.026). In more detail, participants with Lp(a) ≥ 50 mg/dL in the highest quartile of Total-C, LDL-C and TG showed evidence of additive interaction in CAD, with relative excess risk due to interaction (RERI) of 0.42 (0.17, 0.67), 0.44 (0.18, 0.71), and 0.39 (0.12, 0.67), respectively. No such interactions were observed in CAVS and IS.