Associations Between Lipoprotein(a) Levels and Cardiovascular Outcomes in Black and White Subjects The Atherosclerosis Risk in Communities (ARIC) Study

作者：Virani Salim S; Brautbar Ariel; Davis Brian C; Nambi Vijay; Hoogeveen Ron C; Sharrett A Richey; Coresh Josef; Mosley Thomas H; Morrisett Joel D; Catellier Diane J; Folsom Aaron R; Boerwinkle Eric; Ballantyne Christie M^*

来源：Circulation, 2012, 125(2): 241-U154.

DOI：10.1161/CIRCULATIONAHA.111.045120

• cardiovascular diseases
• ethnic groups
• lipoproteins
• race
• risk factors

Background-On the basis of studies with limited statistical power, lipoprotein(a) [Lp(a)] is not considered a risk factor for cardiovascular disease (CVD) in blacks. We evaluated associations between Lp(a) and incident CVD events in blacks and whites in the Atherosclerosis Risk in Communities (ARIC) study. %26lt;br%26gt;Methods and Results-Plasma Lp(a) was measured in blacks (n = 3467) and whites (n = 9851). Hazards ratios (HRs) for incident CVD events (coronary heart disease and ischemic strokes) were calculated. Lp(a) levels were higher with wider interindividual variation in blacks (median [interquartile range], 12.8 [7.1-21.7] mg/dL) than whites (4.3 [1.7-9.5] mg/dL; P %26lt; 0.0001). At 20 years of follow-up, 676 CVD events occurred in blacks, and 1821 events occurred in whites. Adjusted HRs (95% confidence interval) per race-specific 1-SD-greater log-transformed Lp(a) were 1.13 (1.04-1.23) for incident CVD, 1.11 (1.00-1.22) for incident coronary heart disease, and 1.21 (1.06-1.39) for ischemic strokes in blacks. For whites, the respective HRs (95% confidence intervals) were 1.09 (1.04-1.15), 1.10 (1.05-1.16), and 1.07 (0.97-1.19). Quintile analyses showed that risk for incident CVD was graded but statistically significant only for the highest compared with the lowest quintile (HR [95% confidence interval], 1.35 [1.06-1.74] for blacks and 1.27 [1.10-1.47] for whites). Similar results were obtained with the use of Lp(a) cutoffs of %26lt;= 10 mg/dL, %26gt;10 to %26lt;= 20 mg/dL, %26gt;20 to %26lt;= 30 mg/dL, and %26gt;30 mg/dL. %26lt;br%26gt;Conclusions-Lp(a) levels were positively associated with CVD events. Associations were at least as strong, with a larger range of Lp(a) concentrations, in blacks compared with whites. (Circulation. 2012;125:241-249.)

• 出版日期2012-1-17