OBJECTIVE High Lp(a) (lipoprotein[a]) cause cardiovascular disease (CVD) in a primary prevention setting; however, it is debated whether high Lp(a) lead to recurrent CVD events. We tested the latter hypothesis and estimated the Lp(a)-lowering needed for 5 years to reduce CVD events in a secondary prevention setting. Approach and Results: From the CGPS (Copenhagen General Population Study; 2003-2015) of 58 527 individuals with measurements of Lp(a), 2527 aged 20 to 79 with a history of CVD were studied. The primary end point was major adverse cardiovascular event (MACE). We also studied 1115 individuals with CVD from the CCHS (Copenhagen City Heart Study; 1991-1994) and the CIHDS (Copenhagen Ischemic Heart Disease Study; 1991-1993). During a median follow-up of 5 years (range, 0-13), 493 individuals (20%) experienced a MACE in the CGPS. MACE incidence rates per 1000 person-years were 29 (95% CI, 25-34) for individuals with Lp(a)<10 mg/dL, 35 (30-41) for 10 to 49 mg/dL, 42 (34-51) for 50 to 99 mg/dL, and 54 (42-70) for ≥100 mg/dL. Compared with individuals with Lp(a)<10 mg/dL (18 nmol/L), the multifactorially adjusted MACE incidence rate ratios were 1.28 (95% CI, 1.03-1.58) for 10 to 49 mg/dL (18-104 nmol/L), 1.44 (1.12-1.85) for 50 to 99 mg/dL (105-213 nmol/L), and 2.14 (1.57-2.92) for ≥100 mg/dL (214 nmol/L). Independent confirmation was obtained in individuals from the CCHS and CIHDS. To achieve 20% and 40% MACE risk reduction in secondary prevention, we estimated that plasma Lp(a) should be lowered by 50 mg/dL (95% CI, 27-138; 105 nmol/L [55-297]) and 99 mg/dL (95% CI, 54-273; 212 nmol/L [114-592]) for 5 years. CONCLUSIONS High concentrations of Lp(a) are associated with high risk of recurrent CVD in individuals from the general population. This study suggests that Lp(a)-lowering by 50 mg/dL (105 nmol/L) short-term (ie, 5 years) may reduce CVD by 20% in a secondary prevention setting.

中文翻译：

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一项基于人群的研究，可能需要降低脂蛋白（a）50 mg / dL（105 nmol / L）才能将心血管疾病降低20％。

目的高Lp（a）（脂蛋白[a]）可在一级预防环境中引起心血管疾病（CVD）；然而，存在争议的是，高Lp（a）是否会导致复发性CVD事件。我们测试了后一种假设，并估计了在二级预防环境中降低Lp（a）所需的5年时间，以减少CVD事件。方法和结果：从CGPS（哥本哈根普通人群研究； 2003-2015年）中，对58 527名Lp（a）个体进行了研究，研究了2527名20岁至79岁有CVD病史的人。主要终点是重大不良心血管事件（MACE）。我们还从CCHS（哥本哈根市心脏研究； 1991-1994）和CIHDS（哥本哈根缺血性心脏病研究； 1991-1993）中研究了1115例CVD患者。在5年的中位随访时间（范围0-13）中，有493人（占20％）在CGPS中经历了MACE。Lp（a）<10 mg / dL的个体每1000人年的MACE发生率为29（95％CI，25-34），10至49 mg / dL的个体为35（30-41），42（34- 51）适用于50至99 mg / dL，54（42-70）适用于≥100mg / dL。与Lp（a）<10 mg / dL（18 nmol / L）的个体相比，经多因素调整的MACE发生率比率为10至49 mg / dL（18-104 nmol）为1.28（95％CI，1.03-1.58） / L），50至99 mg / dL（105-213 nmol / L）为1.44（1.12-1.85），≥100mg / dL（214 nmol / L）为2.14（1.57-2.92）。来自CCHS和CIHDS的个人获得了独立确认。为了使二级预防中的MACE风险降低20％和40％，我们估计血浆Lp（a）应降低50 mg / dL（95％CI，27-138； 105 nmol / L [55-297]），并且99 mg / dL（95％CI，54-273; 212 nmol / L [114-592]），持续5年。结论高浓度的Lp（a）与普通人群中复发性CVD的高风险有关。这项研究表明，在二级预防环境中，短期（即5年）降低Lp（a）50 mg / dL（105 nmol / L）可使CVD降低20％。