国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Effect of Lipoprotein(a) on Stroke Recurrence Attenuates at Low LDL-C (Low-Density Lipoprotein) and Inflammation Levels

第一作者：Jie Xu；Xiwa Hao；Rui Zhan

通讯作者：Yongjun Wang;Lemin Zheng

apolipoprotein；cardiovascular disease； inflammation； ischemic stroke；phospholipid

基本信息

2022-04-12

已发表文章

发表杂志：Stroke

发表类型: Original Contributions

影响因子(IF): 10.17

PMID: 35410491 Pubmed原文链接 全文下载

主要研究背景及目的

The abundance of evidence from genetic, epidemiologic, and clinical studies have investigated the association of elevated lipoprotein(a) (Lp(a)) concentrations and cardiovascular diseases. Lp(a) is composed of a lowdensity lipoprotein (LDL)-like moiety bound covalently to apolipoprotein(a). Elevated Lp(a) confers risk predominantly in conjunction with elevated levels of low-density lipoprotein cholesterol (LDL-C) and proinflammatory effects of its oxidized phospholipid content. In present, the evidence about the role of Lp(a) in predicting ischemic stroke recurrence is limited and debated. Recently, one study found that the cardiovsacular risk associated with high Lp(a) levels would largely be attenuated at low LDL-C, meanwhile another research showed similar trend under low hsCRP levels. Lipids and inflammation are the two cornerstones of atherosclerotic plaque. Our question is, if LDL-C and inflammation levels are both at a very low level, does the residual risk of Lpa still exist? Hence, we aim to investigate the contribution of Lp(a) to stroke recurrence at different LDL-C and inflammation levels among patients with ischaemic stroke (IS) or transient ischaemic attack (TIA) from the Third China National Stroke Registry (CNSR-III).

方法

This prospective cohort study included 9899 patients with ischemic stroke or transient ischemic attack from the Third China National Stroke Registry who had measurements of plasma Lp(a) and were followed up for 1 year. Cutoffs were set at the 50 mg/dL for Lp(a). LDL-C was corrected for Lp(a)-derived cholesterol (LDL-Cc [LDL-C corrected]) and cutoffs were set at 55 and 70 mg/dL.The threshold values of IL-6 (interleukin 6) and hsCRP (high-sensitive C-reactive protein) were the median 2.65 ng/L and 2 mg/L. Multivariable-adjusted hazard ratio (HR) were calculated using Cox regression models for each category to investigate the associations of Lp(a) with stroke recurrence within 1 year

结论

Increased Lp(a) was significantly associated with stroke recurrence risk in patients with ischemic stroke/transient ischemic attack. However, at low LDL-Cc or IL-6 levels, the elevated Lp(a) -associated stroke recurrence risk was attenuated in a secondary prevention setting.

主要结果

Among all patients, those with Lp(a) ≥50 mg/dL were at higher stroke recurrence risk than those with Lp(a) <50 mg/dL (11.5% versus 9.4%; adjusted HR, 1.20 [95% CI, 1.02–1.42]). However, the risk associated with elevated Lp(a) was attenuated in patients with LDL-Cc <55 mg/dL (high Lp(a) versus low Lp(a): 8.9% versus 9.0%; adjusted HR, 0.92 [95% CI, 0.65–1.30]) or IL-6 <2.65 ng/L (9.0% versus 7.8%; adjusted HR, 1.14 [95% CI, 0.87–1.49]). Notably, in the group with both low LDL-Cc and inflammation levels, the rate of patients with high Lp(a) did not significantly different from the rate of patients with low Lp(a; LDL-Cc <55 mg/dL and IL-6 <2.65 ng/L: 6.2% versus 7.1%; adjusted HR, 0.86 [95% CI, 0.46–1.62]; LDL-Cc <55 mg/dL and hsCRP <2 mg/L: 7.7% versus 7.6%; adjusted HR, 0.97 [95% CI, 0.57–1.66]). However, there was no interaction between the LDL-Cc, IL-6, hsCRP, and Lp(a) levels on stroke recurrence risk