González-Juanatey José Ramón, Cordero Alberto, Vitale Gustavo C, González-Timón Belén, Mazón Pilar, Bertomeu Vicente
Servicio de Cardiología, Complejo Hospitalario Universitario Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
Rev Esp Cardiol. 2011 Oct;64(10):862-8. doi: 10.1016/j.recesp.2011.05.022. Epub 2011 Aug 10.
Residual lipid risk has been defined as the excess of cardiovascular events observed in patients with adequate control of low-density lipoprotein cholesterol and has been mainly attributed to high-density lipoprotein cholesterol and triglycerides. The aim of our study was to describe the clinical features and the magnitude and characteristics associated with residual lipid risk in patients with a history of coronary revascularization.
Multicenter, observational, cross-sectional study of patients with a history of coronary revascularization. Residual lipid risk was defined as the presence of high-density lipoprotein cholesterol <40 mg/dL and/or triglycerides >150 mg/dL in patients with low-density lipoprotein cholesterol <100 mg/dL.
We included 2292 patients with a mean age of 65.5 (12.4) years; 94.1% were receiving no statin therapy and 4.8% no lipid therapy. Statin-only therapy (74%) was the most common strategy, followed by combination with ezetimibe (17%). The prevalence of high-density lipoprotein cholesterol <40 mg/dL was 35.8%, hypertriglyceridemia 38.9%, and low-density lipoprotein cholesterol >100 mg/dL 44.9%; the residual lipid risk group included 29.9% of all patients. This patient group had a similar clinical profile except for slightly lower mean age, higher incidence of diabetes, and higher proportion of men. Multivariate analysis identified positive associations of diabetes and male sex with residual lipid risk; current smoking, male sex, and fibrate therapy were associated with high-density lipoprotein cholesterol <40 mg/dL; current smoking, abdominal obesity, and fibrate therapy were associated with hypertriglyceridemia.
In daily clinical practice, almost one-third of patients with a history of coronary revascularization have low-density lipoprotein cholesterol <100 mg/dL plus low high-density lipoprotein cholesterol and/or hypertriglyceridemia, a concept known as residual lipid risk.
残余血脂风险被定义为低密度脂蛋白胆固醇得到充分控制的患者中观察到的心血管事件超额风险，主要归因于高密度脂蛋白胆固醇和甘油三酯。我们研究的目的是描述有冠状动脉血运重建史患者的临床特征以及与残余血脂风险相关的程度和特点。
对有冠状动脉血运重建史的患者进行多中心、观察性横断面研究。残余血脂风险定义为低密度脂蛋白胆固醇<100mg/dL的患者中高密度脂蛋白胆固醇<40mg/dL和/或甘油三酯>150mg/dL。
我们纳入了2292例患者，平均年龄65.5（12.4）岁；94.1%未接受他汀类治疗，4.8%未接受降脂治疗。仅使用他汀类药物治疗（74%）是最常见的策略，其次是与依泽替米贝联合使用（17%）。高密度脂蛋白胆固醇<40mg/dL的患病率为35.8%，高甘油三酯血症为38.9%，低密度脂蛋白胆固醇>100mg/dL为44.9%；残余血脂风险组占所有患者的29.9%。该患者组具有相似的临床特征，只是平均年龄略低、糖尿病发病率较高且男性比例较高。多变量分析确定糖尿病和男性与残余血脂风险呈正相关；当前吸烟、男性和贝特类药物治疗与高密度脂蛋白胆固醇<40mg/dL相关；当前吸烟、腹型肥胖和贝特类药物治疗与高甘油三酯血症相关。
在日常临床实践中，近三分之一有冠状动脉血运重建史的患者低密度脂蛋白胆固醇<100mg/dL，同时伴有高密度脂蛋白胆固醇降低和/或高甘油三酯血症，这一概念称为残余血脂风险。
