Correlation Between Serum Lipoprotein(a) And Left Ventricular Structural Parameters In Elderly Hypertensive Patients

Objective: To investigate whether lipoprotein(a)(Lp(a))is overexpressed in elderly patients with essential hypertension,especially those with cardiac structural changes,and the correlation between Lp(a)levels and left heart structural parameters in elderly patients with hypertension.To investigate whether Lp(a)can be a risk factor and predictor of hypertension cardiac remodeling,and to explore the clinical value of Lp(a)in the severity assessment of cardiac involvement in elderly patients with essential hypertension.Method:1 Subjects: Elderly patients who was hospitalized in the Department of Cardiology of Hebei General Hospital from November 2018 to March 2019 were selected as screening objects.The inclusion criteria were patients aged 65 years and older who were diagnosed as essential hypertension(for diagnosis of essential hypertension,refer to the 2018 Revised Chinese Guidelines of Prevention and Treatment of Hypertension).Exclusion criteria: Patients with atrial fibrillation,heart valve disease,myocardial infarction,heart failure,tumours,acute and chronic inflammatory states,type 2 diabetes,and other diseases that may affect left heart structural parameters.According to the level of Left atrial diameter(LAD),the study subjects were divided into 43 cases(66%)in the negative group and 22 cases(34%)in the positive group.(The standard for normal and enlarged LAD is based on the 2015 American Society of Echocardiography Quantitative Guidelines for Cardiac Cavity,female: Normal LAD 27-38 mm Left atrial dilatation ?39mm;male: Normal LAD 30-40 mm Left atrial dilatation ?41mm).2 Data collection: Collect and record the general conditions of the study subjects,including gender,age,hypertension grade,and the duration of hypertension.Laboratory indicators include triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),and Lp(a)results.The laboratory indicators are the full biochemical test report of the Laboratory Department of Hebei General Hospital: fasting blood was collected from the patients and tested by a professional laboratory technician(American,BECKMAN COULTER au5800)in the laboratory.The cardiac colour Doppler ultrasound indexes were based on the report issued by the Ultrasound Department of Hebei General Hospital,which operated by a professional technician,using a(Japan,PHILIPS EPIQ7C)colour Doppler ultrasound diagnostic instrument with a probe frequency of 2 ? 4MHz.The patient took a left supine and supine position,breathing peacefully,observing the morphology and structure of the heart on different sections,using colour Doppler and spectral Doppler to measure LAD,Interventricular septal thickness at diastole(IVS),left ventricular end systolic diameter(ESD)and left ventricular end diastolic diameter(EDD).3 Statistical method: SPSS 23.0 statistical software was used to analyze the experimental data.The categorical variables in the two groups used the chi-square test.The measurement data in the two groups conformed to the normal distribution using the mean ± standard deviation(x ± SD),and the comparison between the two groups was performed using independent-samples T test;the measurement data in the two groups did not conform to the normal distribution using the median((25th quantile,75 th quantile)[M(P25,P75)] indicates that the comparison between the two groups was performed using the Mann-Whitney U rank sum test.Correlation was evaluated using Spearman rank correlation analysis.In order to eliminate the influence of extreme values on the statistical model,some measurement data are analyzed by logarithmic conversion.Logistic regression was used to explore independent risk factors for cardiac involvement(left atrial dilatation)in elderly patients with essential hypertension.Calculate the area under the receiver operating characteristic(ROC)curve for Lp(a)in diagnosing heart disease in elderly patients with hypertension,and evaluate its diagnostic value for heart disease in elderly patients with hypertension.P <0.05 was considered statistically significant.Results:65 elderly patients with essential hypertension were included in this study,including 25 males and 40 females,aged 65-92 years,with an average age of 73.7 ± 7.3 years.There was no significant difference in gender and age between the two groups(P> 0.05).1.Compared with the negative group,the duration of hypertension,and Lp(a)in the positive group were significantly increased(P<0.05).2.LAD was significantly correlated with the age of the patients,the duration of hypertension,EDD and Lp(a).Lp(a)was significantly correlated with the age of the patients and the LAD(P<0.05).3.Through logistic regression analysis,it was found that the duration of hypertension(OR=1.060,95%CI: 1.008-1.116)and Lp(a)[OR=6.394,95%CI:1.038-39.396] are independent risk factors for the heart involvement(expansion of the LAD).4.In the positive diagnosis,the area under the ROC curve of Lp(a)is 0.665(0.524,0.806).Conclusion:Detection of serum Lp(a)levels in elderly hypertensive patients is helpful to assess the degree of cardiac remodeling in patients with hypertension,and has a practical significance for the risk assessment of cardiac remodeling in elderly hypertensive patients.