脂蛋白升高患者心血管结局的性别差异(a)。

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.081

Ahmed Mazen Amin MB ChB, Ahmed Mansour MB ChB, Mohamed Abdelwahab Mohamed Yassin MB ChB, James Mills MD, Basel Abdelazeem MD

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引用次数: 0

摘要

背景/简介脂蛋白(a) [Lp(a)]具有促血栓和促动脉粥样硬化的特性，其升高与各种动脉粥样硬化性心血管疾病（ASCVD）的风险升高有关，如外周动脉疾病、中风和急性心肌梗死（AMI）。然而，评估不同性别的Lp(a)水平升高的风险及其与长期心血管事件的关系的研究是有限的。目的/目的本研究旨在通过一项回顾性队列的综合分析，评估Lp(a)升高的男性与女性患者的长期心血管结局。方法本研究利用TriNetX研究网络的数据。从超过1.2亿条记录的队列（从2016年1月到2021年5月）中，确定了15654名成年参与者（≥18岁）Lp(a)水平升高。我们排除了性别不明的个体；剩下的被分成男女两组。基于基线特征进行倾向评分匹配（1:1）。我们的主要终点是新发心房颤动（NOAF）。结果我们的研究包括来自TriNetX数据库的6484名男性和7201名女性患者。经PSM后，每组5094只。男性患者发生NOAF的风险较高(风险比：1.678,95% CI [1.356, 2.075], p <；0.001), ASCVD (HR: 1.158, 95% CI [1.083, 1.239], p <；0.001)、新发缺血性心脏病（NO-IHD）（HR: 1.282, 95% CI [1.106, 1.486], p = 0.001）、新发主动脉瓣狭窄（NO-AVS）（HR: 1.499, 95% CI [1.031, 2.179], p = 0.033）。然而，在缺血性卒中、全因住院、AMI、新发心力衰竭、全身性栓塞、血栓栓塞和全因死亡率方面没有观察到显著差异。结论：小患者Lp(a)水平升高与不良心血管结局的风险增加相关，包括NOAF、ASCVD、NO-IHD和NO-AVS。在评估心血管风险和计划治疗时应考虑到这种性别特异性风险。

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Sex differences in cardiovascular outcomes among patients with elevated Lipoprotein(a).

Background/Synopsis

Lipoprotein(a) [Lp(a)] has a prothrombotic and proatherogenic nature, and its elevation has been associated with an elevated risk of various atherosclerotic cardiovascular disease (ASCVD) conditions, such as peripheral arterial disease, stroke, and acute myocardial infarction (AMI). However, the studies that evaluated the risk of elevated Lp(a) levels in different genders and its relation with long-term cardiovascular events are limited.

Objective/Purpose

This study aims to assess long-term cardiovascular outcomes in male versus female patients with elevated Lp(a) through a comprehensive analysis of a retrospective cohort.

Methods

This study utilized data from the TriNetX Research Network. From a cohort of over 120 million records (spanning January 2016 to May 2021) 15,654 adult participants (≥ 18 years) with elevated Lp(a) levels were identified. We excluded individuals with unspecified sex; the remaining were divided into male and female groups. Propensity score matching (PSM) (1:1) based on baseline characteristics was performed. Our primary outcome was new-onset atrial fibrillation (NOAF).

Results

Our study included 6,484 male and 7,201 female patients from the TriNetX database. After PSM, there were 5,094 in each group. Male patients were associated with a higher risk of NOAF (Hazard Ratio (HR): 1.678, 95% CI [1.356, 2.075], p < 0.001), ASCVD (HR: 1.158, 95% CI [1.083, 1.239], p < 0.001), new-onset ischemic heart disease (NO-IHD) (HR: 1.282, 95% CI [1.106, 1.486], p = 0.001), new-onset aortic valve stenosis (NO-AVS) (HR: 1.499, 95% CI [1.031, 2.179], p = 0.033). However, no significant differences were observed in ischemic stroke, all-cause hospitalization, AMI, new-onset heart failure, systemic embolism, thromboembolism, and all-cause mortality.

Conclusions

Male patients with elevated Lp(a) levels were associated with an increased risk of adverse cardiovascular outcomes, including NOAF, ASCVD, NO-IHD, and NO-AVS. This gender-specific risk should be considered when evaluating cardiovascular risk and planning treatment.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.