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Circulation:载脂蛋白B与冠状动脉疾病和外周动脉疾病风险的相关性

2021-08-08 Nebula MedSci原创

ApoB被认定为主要的脂蛋白组分,与PAD和CAD风险都有因果关系

脂蛋白相关特征一直被认为是动脉粥样硬化性血管疾病的危险因素,这主要是基于冠状动脉疾病(CAD)的研究。特定脂蛋白对外周动脉疾病(PAD)风险的相对贡献尚不明确。

Levin等研究人员利用大规模的遗传关联数据研究了循环脂蛋白相关性状对PAD风险的影响,研究结果于近日发表在“Circulation”上。

Prioritizing the Role of Major Lipoproteins and Subfractions as Risk Factors for Peripheral Artery Disease

研究人员在孟德尔随机贝叶斯模型平均框架中使用循环脂蛋白相关性状的全基因组关联研究摘要统计数据,以优先考虑PAD和CAD中最有可能的主要脂蛋白和次级危险因素。采用孟德尔随机化方法评估载脂蛋白B (ApoB) 降低PAD风险的作用。

分析结果显示,ApoB是PAD和CAD最可能的脂蛋白相关危险因素(边际纳入概率分别是0.86[P=0.003]和0.92[P=0.005])。降低载脂蛋白药物的遗传指标与PAD和CAD的风险降低均相关(ApoB每降低1SD的优势比分别是0.87和0.66;P<0.0001),其中ApoB降低对CAD的预测作用更强(作用效应比 3.09;P<1x10-6)。

遗传预测ApoB水平与PAD的相关性

此外,研究人员还发现,超小极低密度脂蛋白颗粒浓度最可能与PAD风险相关,而大低密度脂蛋白颗粒浓度则最可能与CAD风险相关。与超小极低密度脂蛋白颗粒和大浓度低密度脂蛋白颗粒相关的基因包括经典ApoB通路基因,虽然基因特异性的影响是可变的。脂蛋白(a)独立于ApoB与PAD风险增加相关(优势比 1.04;P=1x10-33)。

综上所述,ApoB被认定为主要的脂蛋白组分,与PAD和CAD风险都有因果关系。但是,降低ApoB药物靶点和含ApoB的脂蛋白亚组分与动脉粥样硬化心血管疾病有不同的关联;不同的亚组分相关基因表明,脂蛋白在PAD和CAD发病机制中的作用可能存在差异。

原始出处:

Michael G. Levin, et al. Prioritizing the Role of Major Lipoproteins and Subfractions as Risk Factors for Peripheral Artery Disease. Circulation. 2021;144:353–364

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  5. 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  6. 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encodeId=ed9a1006351c3, content=治疗目标量化?, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:45:30 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006350, encodeId=583f100635096, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:43:50 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006102, encodeId=d3eb100610237, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211207/2f7665d08e1b4c2a90bcc34a76de6474/984f9e667a064e58a1c59279fdc0bb63.jpg, createdBy=2d8c5470248, createdName=ms5000000716895377, createdTime=Sun Aug 08 19:29:07 CST 2021, time=2021-08-08, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1691556, encodeId=e80616915563a, content=<a href='/topic/show?id=29ba9365035' target=_blank style='color:#2F92EE;'>#载脂蛋白B#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93650, encryptionId=29ba9365035, topicName=载脂蛋白B)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed8829226564, createdName=liubm565, createdTime=Fri Apr 15 20:14:50 CST 2022, time=2022-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1837971, encodeId=b313183e9713e, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, 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encodeId=ed9a1006351c3, content=治疗目标量化?, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:45:30 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006350, encodeId=583f100635096, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:43:50 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006102, encodeId=d3eb100610237, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211207/2f7665d08e1b4c2a90bcc34a76de6474/984f9e667a064e58a1c59279fdc0bb63.jpg, createdBy=2d8c5470248, createdName=ms5000000716895377, createdTime=Sun Aug 08 19:29:07 CST 2021, time=2021-08-08, status=1, ipAttribution=)]
    2021-08-09 forvalen

    治疗目标量化?

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1691556, encodeId=e80616915563a, content=<a href='/topic/show?id=29ba9365035' target=_blank style='color:#2F92EE;'>#载脂蛋白B#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93650, encryptionId=29ba9365035, topicName=载脂蛋白B)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ed8829226564, createdName=liubm565, createdTime=Fri Apr 15 20:14:50 CST 2022, time=2022-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1837971, encodeId=b313183e9713e, content=<a href='/topic/show?id=3f34e253206' target=_blank style='color:#2F92EE;'>#相关性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72532, encryptionId=3f34e253206, topicName=相关性)], attachment=null, authenticateStatus=null, createdAvatar=, 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encodeId=ed9a1006351c3, content=治疗目标量化?, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:45:30 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006350, encodeId=583f100635096, content=好好学, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210512/b39c8bc0ab334969ba4ccc08e7a6cd94/c4e41798ef27449aa31ad740c9b13062.jpg, createdBy=5ff35133022, createdName=forvalen, createdTime=Mon Aug 09 15:43:50 CST 2021, time=2021-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1006102, encodeId=d3eb100610237, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211207/2f7665d08e1b4c2a90bcc34a76de6474/984f9e667a064e58a1c59279fdc0bb63.jpg, createdBy=2d8c5470248, createdName=ms5000000716895377, createdTime=Sun Aug 08 19:29:07 CST 2021, time=2021-08-08, status=1, ipAttribution=)]
    2021-08-09 forvalen

    好好学

    0

  10. 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GetPortalCommentsPageByObjectIdResponse(id=1006102, encodeId=d3eb100610237, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211207/2f7665d08e1b4c2a90bcc34a76de6474/984f9e667a064e58a1c59279fdc0bb63.jpg, createdBy=2d8c5470248, createdName=ms5000000716895377, createdTime=Sun Aug 08 19:29:07 CST 2021, time=2021-08-08, status=1, ipAttribution=)]
    2021-08-08 ms5000000716895377

    学习

    0

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如果三支血管同时病变的患者通过PCI不可能实现完全(或接近完全)血运重建,则应考虑采用CABG治疗

JACC:复杂性冠状动脉疾病老年患者采用不同血运重建术后的10年随访结果

存在3根血管或左主干血管病变的老年患者无论是采用经皮冠脉介入治疗还是冠状动脉搭桥术治疗的10年全因死亡率、寿命、5年MACCE和5年QOL状态均无显著差异

Eur Heart J:选择性冠脉重建相比药物治疗可进一步改善冠心病患者预后

对于稳定性冠状动脉疾病患者,与单纯药物治疗相比,选择性冠状动脉重建联合药物治疗可降低心源性死亡率

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