| Objective To investigate the value of lipoprotein（a）[Lp（a）]in predicting atherosclerosis progression and the risk of cardiovascular event recurrence in patients with coronary heart disease after stenting at different low density lipoprotein cholesterol（LDL-C）levels in case-control and cohort studies.Part oneMethods A total of 782 patients with coronary heart disease who received coronary stent implantation in our hospital from January 2015 to December 2019 and underwent re-angiography 1 year after surgery were included.Their demographic information,general clinical data,past medical history,laboratory examination results and coronary angiography information were collected.According to the results of coronary angiography,the patients were divided into atherosclerosis progression group and non-progression group,and the independent risk factors of coronary artery disease progression were analyzed by multivariate Logistic regression.The patients were then divided into three subgroups according to the LDL-C levels after treatment（S1:LDL-C<1.4mmol/L,S2:1.4≤LDL-C<1.8mmol/L,S3:LDL-C≥1.8mmol/L）,and the correlation between Lp（a）elevations and lesion progression in each group was compared.Results 1.The levels of LDL-C,Lp（a）,fasting blood glucose and hypersensitive C-reactive protein（HS-CRP）in the progression group were significantly higher than those in the non-progression group.The incidence of diabetes,family history of cardiovascular disease and continuous smoking were more common.And there were more coronary lesions and more stent implantation in the progression group（P<0.05）.2.Multivariate Logistic regression analysis showed diabetes mellitus（OR=1.40,95%CI:1.01-1.94）,family history（OR=1.73,95%CI:1.04-2.87）,continuous smoking（OR=2.22,95%CI:1.23-4.02）,LDL-C levels after treatment（OR=1.68,95%CI:1.23-2.28）,the number of lesion vessels（OR=1.35,95%CI:1.09-1.67）and Lp（a）elevations（OR=1.86,95%CI:1.52-3.21）were risk factors for the atherosclerotic progression.3.Subgroup analysis showed that when LDL-C≥1.8mmol/L,Lp（a）elevations were significantly correlated with disease progression（OR=2.28,95%CI:1.43-4.82,P<0.001）.When LDL-C=1.4-1.8mmol/L,the relationship was still close（OR=1.93,95%CI:1.38-3.89,P=0.004）.However,when LDL-C<1.4mmol/L,Lp（a）elevations were not correlated with the progression of the disease（OR=1.13,95%CI:0.52-1.86,P=0.43）.Conclusion The correlation between Lp（a）and the progression of atherosclerotic lesions was affected by LDL-C levels.When LDL-C levels are high,Lp（a）elevations can predict the progression of atherosclerosis independently.But when LDL-C levels are low,there is no significant correlation between them.In addition,diabetes mellitus,continued smoking,family history of cardiovascular disease,poor LDL-C control,and severe underlying coronary artery disease were independently associated with rapid progression of atherosclerosis.Part twoMethods A total of 516 patients with coronary heart disease who received coronary stent implantation in our hospital from January to December 2017 were included in this study.Their general clinical data,laboratory examination results and coronary angiographic characteristics were collected and followed up for three years.According to Lp（a）levels,the two groups were divided into normal Lp（a）group and increased Lp（a）group,and the incidence of major adverse cardiovascular events（MACE）and acute coronary events（ACE）were compared.The patients were divided into three subgroups according to LDL-C levels after treatment,and the correlation between Lp（a）increase and the risk of cardiovascular events was analyzed by Cox proportional risk model in different subgroups.Results The incidence of MACE and ACE in high-Lp（a）group was significantly higher than that in low-Lp（a）group（P<0.05）.Overall analysis showed that Lp（a）had statistically independent prognostic value for cardiovascular events（MACE:HR=1.63,95%CI=1.12-2.38;ACE:HR=1.70,95%CI=1.03-2.81）;However,subgroup analysis showed that Lp（a）elevations were not independently associated with adverse cardiovascular outcomes in the total LDL-C range.Lp（a）elevations were independently associatedwith increased cardiovascular risk in patients with LDL-C≥1.4mmol/L（S1:MACE:HR=1.62,95%CI=0.95-2.77;ACE:HR=2.33,95%CI=1.15-4.72;S2:MACE:HR=2.65,95%CI:1.31-5.36;ACE:HR=2.01,95%CI=0.77-5.23）,but this correlation no longer existed when LDL-C<1.4mmol/L（S3:MACE:HR=0.49,95%CI=0.17-1.42;ACE:HR=0.68,95%CI=0.18-2.6）.Conclusion LDL-C levels may have a "permissive effect" on Lp（a）in predicting the risk of recurrence of adverse cardiovascular events.Higher Lp（a）levels were independently associated with adverse cardiovascular outcomes when LDL-C levels were high,and his correlation disappeared when LDL-C levels were low（<1.4 mmol/L）.Patients with LDL-C≥1.4mmol/L and Lp（a）elevations should be regarded as a high-risk group for recurrent cardiovascular events,and further lipid-lowering therapy is required to control LDL-C below 1.4mmol/L. |
PDF Full Text Request