Lipoprotein(a) is associated with coronary atheroma progression: analysis from a serial coronary computed tomography angiography study

摘要

BACKGROUND Lipoprotein(a)[Lp(a)]has been closely related to coronary atherosclerosis and might affect perivascular in-flammation due to its proinflammatory properties.However,there are limited data about Lp(a)and related perivascular inflam-mation on coronary atheroma progression.Therefore,this study aimed to investigate the associations between Lp(a)and the peri-vascular fat attenuation index(FAI)with coronary atheroma progression detected by coronary computed tomography angio-graphy(CCTA).METHODS Patients who underwent serial CCTA examinations without a history of revascularization and with available data for Lp(a)within one month before or after baseline and follow-up CCTA imaging scans were considered to be included.CCTA quantitative analyses were performed to obtain the total plaque volume(TPV)and the perivascular FAI.Coronary plaque pro-gression(PP)was defined as a≥10%increase in the change of the TPV at the patient level or the presence of new-onset coronary atheroma lesions.The associations between Lp(a)or the perivascular FAI with PP were examined by multivariate logistic regres-sion.RESULTS A total of 116 patients were ultimately enrolled in the present study with a mean CCTA interscan interval of 30.80±13.50 months.Among the 116 patients(mean age:53.49±10.21 years,males:83.6%),32 patients presented PP during the follow-up interval.Lp(a)levels were significantly higher among PP patients than those among non-PP patients at both baseline[15.80(9.09−33.60)mg/dL vs.10.50(4.75−19.71)mg/dL,P=0.029]and follow-up[20.60(10.45−34.55)mg/dL vs.8.77(5.00−18.78)mg/dL,P=0.004].However,there were no differences in the perivascular FAI between PP group and non-PP group at either baseline or follow-up.Multivariate logistic regression analysis showed that elevated baseline Lp(a)level(OR=1.031,95%CI:1.005−1.058,P=0.019)was an independent risk factor for PP after adjustment for other conventional variables.CONCLUSIONS Lp(a)was independently associated with coronary atheroma progression beyond low-density lipoprotein cholesterol and other conventional risk factors.Further studies are warranted to identify the inflammation effect exhibited as the perivascular FAI on coronary atheroma progression.