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High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a)
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2021-09-06 , DOI: 10.1016/j.jacc.2021.07.016
Wei Zhang 1 , Jaime Lynn Speiser 2 , Fan Ye 1 , Michael Y Tsai 3 , Miguel Cainzos-Achirica 4 , Khurram Nasir 4 , David M Herrington 1 , Michael D Shapiro 1
Affiliation  

Background

Little is known about the relationship between lipoprotein (a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) and their joint association with atherosclerotic cardiovascular disease (ASCVD).

Objectives

The purpose of this study was to assess whether Lp(a)-associated ASCVD risk is modified by hsCRP in the context of primary prevention.

Methods

The current study included 4,679 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) Apolipoprotein ancillary data set. Cox proportional hazards models and Kaplan-Meier curves were used to assess the association among Lp(a), hsCRP, and time to cardiovascular disease (CVD) events.

Results

During a mean follow-up of 13.6 years, 684 CVD events occurred. A significant interaction was observed between Lp(a) and hsCRP (P = 0.04). With hsCRP <2 mg/L, no significant CVD risk was observed at any level of Lp(a) from <50 mg/dL to >100 mg/dL. However, with hsCRP 2 mg/L, a significant CVD risk was observed with Lp(a) of 50-99.9 mg/dL (HR: 1.36; 95% CI: 1.02-1.81) and Lp(a) ≥100 mg/dL (HR: 2.09; 95% CI: 1.40-3.13). Isolated elevations of either Lp(a) or hsCRP were not associated with increased CVD risk. In contrast, the combination of elevated Lp(a) (≥50 mg/dL) and hsCRP (≥2 mg/L) was independently associated with significant CVD risk (HR: 1.62; 95% CI: 1.25-2.10) and all-cause mortality (HR: 1.39; 95% CI: 1.12-1.72).

Conclusions

Lp(a)-associated ASCVD risk is observed only with concomitant elevation of hsCRP. Individuals with concomitant presence of elevated Lp(a) and systemic inflammation have greater ASCVD risk and all-cause mortality, and thus may merit closer surveillance and more aggressive ASCVD risk management.



中文翻译:

高敏 C 反应蛋白可降低脂蛋白 (a) 的心血管风险

背景

关于脂蛋白 (a) [Lp(a)] 和高敏 C 反应蛋白 (hsCRP) 之间的关系以及它们与动脉粥样硬化性心血管疾病 (ASCVD) 的联合关系,人们知之甚少。

目标

本研究的目的是评估一级预防中 hsCRP 是否可以改变 Lp(a) 相关的 ASCVD 风险。

方法

当前的研究包括来自 MESA(动脉粥样硬化多种族研究)载脂蛋白辅助数据集的 4,679 名参与者。Cox 比例风险模型和 Kaplan-Meier 曲线用于评估 Lp(a)、hsCRP 和心血管疾病 (CVD) 事件时间之间的关联。

结果

在平均 13.6 年的随访期间,发生了 684 起 CVD 事件。Lp(a) 和 hsCRP 之间观察到显着的相互作用(P = 0.04)。当 hsCRP < 2 mg/L 时,在 Lp(a) <50 mg/dL 至 >100 mg/dL 的任何水平下均未观察到显着的 CVD 风险。然而,当 hsCRP 2 mg/L 时,Lp(a) 为 50-99.9 mg/dL(HR:1.36;95% CI:1.02-1.81)且 Lp(a) ≥ 100 mg/dL 时,观察到显着的 CVD 风险。 dL(HR:2.09;95% CI:1.40-3.13)。Lp(a) 或 hsCRP 的单独升高与 CVD 风险增加无关。相比之下,升高的 Lp(a) (≥50 mg/dL) 和 hsCRP (≥2 mg/L) 的组合与显着的 CVD 风险独立相关(HR:1.62;95% CI:1.25-2.10),并且所有 -导致死亡(HR:1.39;95% CI:1.12-1.72)。

结论

Lp(a) 相关的 ASCVD 风险仅在 hsCRP 伴随升高时观察到。同时存在 Lp(a) 升高和全身炎症的个体具有更高的 ASCVD 风险和全因死亡率,因此可能值得更密切的监测和更积极的 ASCVD 风险管理。

更新日期:2021-09-07
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