Correlation between lipoprotein (a) and arteriosclerotic cerebral small vessel disease in elderly population without diabetes, hyperlipidemia and hypertension

doi:10.11817/j.issn.1673-9248.2023.05.006

Abstract

Abstract:

Objective

To investigate the correlation between lipoprotein (a) and arteriosclerotic cerebral small vessel disease (aCSVD) in the elderly population without hypertension,hyperlipidemia, or diabetes (abbreviated "no three high").

Methods

2000 patients with aCSVD admitted to Department of Neurology of Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2016 to July 2021 were retrospectively included. Select 4000 cases of the medical check-up who were excluded from aCSVD at the physical examination center during the same period as the control group. The patients were matched by age,sex with a 1∶2 ratio (aCSVD=2000, non aCSVD=4000), and were divided into "no three high" subgroup (aCSVD=198, non aCSVD=396) according to whether they were "no three high" elderly population. The relevant clinical data of the case group and the control group was collected for comparative analysis, and multivariate Logistic regression model was used to analyze the risk factors of aCSVD in the general elderly population and the elderly population without diabetes, hyperlipidemia, and hypertension.

Results

This study showed that after matching the age and gender, the elderly aCSVD group had a higher proportion of hypertension (56.50% vs 55.16%, χ²=1.548, P=0.006), diabetes (42.50% vs 30.00%, χ²=6.796, P=0.009), and hyperlipidemia (33.50% vs 31.50%, χ²=7.614, P=0.006) than the control group, and the differences were statistically significant. The level of lipoprotein (a) in aCSVD group was higher than that in the control group, but there was no statistical difference [(0.32±0.11) g/L vs (0.31±0.12) g/L, t=1.876, P=0.061]. Logistic regression analysis showed that the history of hypertension and diabetes may be an independent risk factor for aCSVD in the elderly, but lipoprotein (a) was not an independent risk factor for aCSVD. In the subgroup analysis, the level of lipoprotein (a) in the "no three high" elderly population with aCSVD was significantly higher than that in the control group, with a statistically significant difference [(0.56±0.17) g/L vs (0.49±0.14) g/L, t=5.339, P＜0.001]. Logistic regression analysis showed that lipoprotein (a) was an independent risk factor for aCSVD in the "no three high" elderly population (OR=1.672, 95%CI: 1.144-2.317, P=0.007).

Conclusion

Lipoprotein (a) is an independent risk factor of aCSVD in the elderly population without diabetes, hyperlipidemia and hypertension, and it can be used as a serum biomarker to predict the risk of aCSVD.

Key words: Cerebral small vessel disease, Lipoprotein (a), “No three high” population, Elderly population

Meijuan Yan, Lihui Shao. Correlation between lipoprotein (a) and arteriosclerotic cerebral small vessel disease in elderly population without diabetes, hyperlipidemia and hypertension[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(05): 458-463.

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Figures/Tables 4

临床资料	aCSVD组（2000例）	对照组（4000例）	统计值	P值
年龄（岁， $x ¯$ ±s）	67.31±10.42	66.98±8.78	t=1.288	0.198
男性[例（%）]	1210（60.50）	2420（60.50）	χ²＜0.001	1.000
吸烟[例（%）]	1300（65.00）	2560（64.00）	χ²=0.581	0.446
饮酒[例（%）]	1470（73.50）	2890（72.25）	χ²=1.049	0.306
高血压病史[例（%）]	1130（56.50）	2110（55.16）	χ²=7.548	0.006
糖尿病史[例（%）]	850（42.50）	1560（30.00）	χ²=6.796	0.009
高脂血症史[例（%）]	670（33.50）	1200（31.50）	χ²=7.614	0.006
空腹血糖（mmol/L， $x ¯$ ±s）	6.98±0.61	6.94±0.43	t=2.937	0.003
HbA1c（%， $x ¯$ ±s）	6.35±1.07	6.29±1.39	t=1.695	0.090
总胆固醇（mmol/L， $x ¯$ ±s）	6.95±1.03	6.93±1.01	t=0.718	0.473
低密度脂蛋白（mmol/L， $x ¯$ ±s）	4.65±0.39	4.64±0.38	t=0.952	0.342
高密度脂蛋白（mmol/L， $x ¯$ ±s）	1.03±0.87	1.05±0.61	t=1.032	0.302
三酰甘油（mmol/L， $x ¯$ ±s）	1.87±0.63	1.85±0.71	t=1.067	0.286
ApoA（g/L， $x ¯$ ±s）	1.52±0.45	1.54±0.51	t=1.488	0.137
ApoB（g/L， $x ¯$ ±s）	1.19±0.65	1.17±0.63	t=1.147	0.251
脂蛋白（a）（g/L， $x ¯$ ±s）	0.32±0.11	0.31±0.12	t=1.876	0.061
HCY（μmol/L， $x ¯$ ±s）	15.59±2.31	15.61±3.31	t=0.242	0.809

临床资料	aCSVD组（2000例）	对照组（4000例）	统计值	P值
年龄（岁， $x ¯$ ±s）	67.31±10.42	66.98±8.78	t=1.288	0.198
男性[例（%）]	1210（60.50）	2420（60.50）	χ²＜0.001	1.000
吸烟[例（%）]	1300（65.00）	2560（64.00）	χ²=0.581	0.446
饮酒[例（%）]	1470（73.50）	2890（72.25）	χ²=1.049	0.306
高血压病史[例（%）]	1130（56.50）	2110（55.16）	χ²=7.548	0.006
糖尿病史[例（%）]	850（42.50）	1560（30.00）	χ²=6.796	0.009
高脂血症史[例（%）]	670（33.50）	1200（31.50）	χ²=7.614	0.006
空腹血糖（mmol/L， $x ¯$ ±s）	6.98±0.61	6.94±0.43	t=2.937	0.003
HbA1c（%， $x ¯$ ±s）	6.35±1.07	6.29±1.39	t=1.695	0.090
总胆固醇（mmol/L， $x ¯$ ±s）	6.95±1.03	6.93±1.01	t=0.718	0.473
低密度脂蛋白（mmol/L， $x ¯$ ±s）	4.65±0.39	4.64±0.38	t=0.952	0.342
高密度脂蛋白（mmol/L， $x ¯$ ±s）	1.03±0.87	1.05±0.61	t=1.032	0.302
三酰甘油（mmol/L， $x ¯$ ±s）	1.87±0.63	1.85±0.71	t=1.067	0.286
ApoA（g/L， $x ¯$ ±s）	1.52±0.45	1.54±0.51	t=1.488	0.137
ApoB（g/L， $x ¯$ ±s）	1.19±0.65	1.17±0.63	t=1.147	0.251
脂蛋白（a）（g/L， $x ¯$ ±s）	0.32±0.11	0.31±0.12	t=1.876	0.061
HCY（μmol/L， $x ¯$ ±s）	15.59±2.31	15.61±3.31	t=0.242	0.809

影响因素	β值	Wald χ²值	OR	95%CI	P值
高血压	0.918	7.157	2.505	1.278~4.908	0.007
糖尿病	1.720	4.362	5.586	1.112~28.063	0.037
高血脂	1.075	1.721	2.930	0.588~14.604	0.190
空腹血糖	0.048	2.635	1.050	0.990~4.908	0.105
HbA1c	1.413	3.157	4.110	0.864~19.543	0.076
脂蛋白（a）	1.328	2.657	3.773	0.764~18.625	0.103

临床资料	aCSVD（198例）	非aCSVD组（396例）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.53±5.73	66.01±5.42	t=0.998	0.319
男性[例（%）]	120（60.61）	240（60.61）	χ²＜0.001	1.000
吸烟[例（%）]	135（68.18）	244（61.62）	χ²=2.464	0.116
饮酒[例（%）]	112（56.57）	205（51.76）	χ²=1.221	0.269
空腹血糖（mmol/L， $x ¯$ ±s）	5.89±0.43	5.83±0.39	t=1.707	0.088
HbA1c（%， $x ¯$ ±s）	6.39±1.01	6.31±1.03	t=0.898	0.369
总胆固醇（mmol/L， $x ¯$ ±s）	5.53±0.98	5.48±1.03	t=0.567	0.571
低密度脂蛋白（mmol/L， $x ¯$ ±s）	3.62±0.98	3.59±1.02	t=0.342	0.732
高密度脂蛋白（mmol/L， $x ¯$ ±s）	1.06±0.67	1.08±0.68	t=0.340	0.737
三酰甘油（mmol/L， $x ¯$ ±s）	1.63±0.62	1.59±0.87	t=0.578	0.564
ApoA（g/L， $x ¯$ ±s）	1.45±0.51	1.52±0.42	t=1.780	0.076
ApoB（g/L， $x ¯$ ±s）	1.11±0.43	1.02±0.65	t=1.764	0.078
脂蛋白（a）（g/L， $x ¯$ ±s）	0.56±0.17	0.49±0.14	t=5.339	＜0.001
HCY（μmol/L， $x ¯$ ±s）	15.76±2.32	15.98±2.89	t=0.931	0.352

临床资料	aCSVD（198例）	非aCSVD组（396例）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.53±5.73	66.01±5.42	t=0.998	0.319
男性[例（%）]	120（60.61）	240（60.61）	χ²＜0.001	1.000
吸烟[例（%）]	135（68.18）	244（61.62）	χ²=2.464	0.116
饮酒[例（%）]	112（56.57）	205（51.76）	χ²=1.221	0.269
空腹血糖（mmol/L， $x ¯$ ±s）	5.89±0.43	5.83±0.39	t=1.707	0.088
HbA1c（%， $x ¯$ ±s）	6.39±1.01	6.31±1.03	t=0.898	0.369
总胆固醇（mmol/L， $x ¯$ ±s）	5.53±0.98	5.48±1.03	t=0.567	0.571
低密度脂蛋白（mmol/L， $x ¯$ ±s）	3.62±0.98	3.59±1.02	t=0.342	0.732
高密度脂蛋白（mmol/L， $x ¯$ ±s）	1.06±0.67	1.08±0.68	t=0.340	0.737
三酰甘油（mmol/L， $x ¯$ ±s）	1.63±0.62	1.59±0.87	t=0.578	0.564
ApoA（g/L， $x ¯$ ±s）	1.45±0.51	1.52±0.42	t=1.780	0.076
ApoB（g/L， $x ¯$ ±s）	1.11±0.43	1.02±0.65	t=1.764	0.078
脂蛋白（a）（g/L， $x ¯$ ±s）	0.56±0.17	0.49±0.14	t=5.339	＜0.001
HCY（μmol/L， $x ¯$ ±s）	15.76±2.32	15.98±2.89	t=0.931	0.352

影响因素	β值	Wald χ²值	OR	95%CI	P值
脂蛋白（a）	0.487	7.276	1.672	1.144~2.317	0.007
ApoA	-0.063	1.386	0.939	0.845~1.043	0.239
ApoB	0.029	0.927	1.029	0.917~1.091	0.336
空腹血糖	0.570	0.613	1.768	0.425~7.360	0.434

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