Abstract：
BACKGROUND: Lipoprotein(a) [Lp(a)] is a recognized as risk factor for atherosclerotic cardiovascular disease (ASCVD). However, its influence on clinical risk evaluations remains unclear.
OBJECTIVE: This study aimed to determine whether Lp(a) improves CVD risk prediction among apparently healthy adults from the general population.
METHODS: In 2002, n = 3,042 adults free of CVD, residing in Athens metropolitan area, in Greece, were recruited. A 20-year follow-up was conducted in 2022, comprising n = 2,169 participants, of which n = 1,988 had complete data for CVD incidence.
RESULTS: Lp(a) levels were significantly associated with 20-year ASCVD incidence in the crude model (Hazard Ratio per 1 mg/dL: 1.004, p = 0.048), but not in multi-adjusted models considering demographic, lifestyle, and clinical factors. Adding Lp(a) to the Reynolds Risk Score (RRS) and Framingham Risk Score (FRS) variables resulted in positive Net Reclassification Improvement (NRI) values (0.159 and 0.160 respectively), indicating improved risk classification. Mediation analysis suggested that C-reactive protein, Interleukin-6, and Fibrinogen mediate the relationship between Lp(a) and ASCVD. No significant interaction was observed between Lp(a) and potential moderators.
CONCLUSIONS: Lp(a) levels can predict 20-year CVD outcomes and improve CVD risk prediction within the general population, possibly via the intricate relationship between Lp(a), systemic inflammation, atherothrombosis.
OBJECTIVE: This study aimed to determine whether Lp(a) improves CVD risk prediction among apparently healthy adults from the general population.
METHODS: In 2002, n = 3,042 adults free of CVD, residing in Athens metropolitan area, in Greece, were recruited. A 20-year follow-up was conducted in 2022, comprising n = 2,169 participants, of which n = 1,988 had complete data for CVD incidence.
RESULTS: Lp(a) levels were significantly associated with 20-year ASCVD incidence in the crude model (Hazard Ratio per 1 mg/dL: 1.004, p = 0.048), but not in multi-adjusted models considering demographic, lifestyle, and clinical factors. Adding Lp(a) to the Reynolds Risk Score (RRS) and Framingham Risk Score (FRS) variables resulted in positive Net Reclassification Improvement (NRI) values (0.159 and 0.160 respectively), indicating improved risk classification. Mediation analysis suggested that C-reactive protein, Interleukin-6, and Fibrinogen mediate the relationship between Lp(a) and ASCVD. No significant interaction was observed between Lp(a) and potential moderators.
CONCLUSIONS: Lp(a) levels can predict 20-year CVD outcomes and improve CVD risk prediction within the general population, possibly via the intricate relationship between Lp(a), systemic inflammation, atherothrombosis.
摘要：
背景：脂蛋白（a）[Lp（a）]是公认的动脉粥样硬化性心血管疾病（ASCVD）的危险因素。然而,其对临床风险评估的影响尚不清楚.
目的：本研究旨在确定Lp(a)是否能改善普通人群中明显健康的成年人的CVD风险预测。
方法：2002年，n=3,042名没有心血管疾病的成年人，居住在雅典都会区，在希腊,被招募。2022年进行了20年的随访，包括2,169名参与者，其中n=1,988有完整的CVD发病率数据。
结果：Lp（a）水平与粗模型中20年ASCVD发病率显着相关（每1mg/dL的危害比：1.004，p=0.048），但在考虑人口统计的多重调整模型中，生活方式,和临床因素。将Lp（a）添加到雷诺兹风险评分（RRS）和弗雷明汉风险评分（FRS）变量中，得出了正的净重新分类改进（NRI）值（分别为0.159和0.160），表明改进的风险分类。中介分析表明，C反应蛋白，白细胞介素-6和纤维蛋白原介导Lp(a)和ASCVD之间的关系。在Lp（a）和潜在的调节剂之间没有观察到显着的相互作用。
结论：Lp(a)水平可以预测20年的CVD结局，并改善一般人群的CVD风险预测，可能是通过Lp(a)、全身性炎症,动脉粥样硬化血栓形成。
目的：本研究旨在确定Lp(a)是否能改善普通人群中明显健康的成年人的CVD风险预测。
方法：2002年，n=3,042名没有心血管疾病的成年人，居住在雅典都会区，在希腊,被招募。2022年进行了20年的随访，包括2,169名参与者，其中n=1,988有完整的CVD发病率数据。
结果：Lp（a）水平与粗模型中20年ASCVD发病率显着相关（每1mg/dL的危害比：1.004，p=0.048），但在考虑人口统计的多重调整模型中，生活方式,和临床因素。将Lp（a）添加到雷诺兹风险评分（RRS）和弗雷明汉风险评分（FRS）变量中，得出了正的净重新分类改进（NRI）值（分别为0.159和0.160），表明改进的风险分类。中介分析表明，C反应蛋白，白细胞介素-6和纤维蛋白原介导Lp(a)和ASCVD之间的关系。在Lp（a）和潜在的调节剂之间没有观察到显着的相互作用。
结论：Lp(a)水平可以预测20年的CVD结局，并改善一般人群的CVD风险预测，可能是通过Lp(a)、全身性炎症,动脉粥样硬化血栓形成。
