低密度脂蛋白胆固醇水平对糖尿病患者急性心肌梗死后2年临床结局的影响。
Impact of low high-density lipoprotein-cholesterol level on 2-year clinical outcomes after acute myocardial infarction in patients with diabetes mellitus.
作者信息
Joo Hyung Joon, Cho Sang-A, Hong Soon Jun, Hur Seung-Ho, Bae Jang-Ho, Choi Dong-Ju, Ahn Young-Keun, Park Jong-Seon, Choi Rak-Kyeong, Choi Donghoon, Kim Joon-Hong, Han Kyoo-Rok, Park Hun-Sik, Choi So-Yeon, Yoon Jung-Han, Kwon Hyeon-Cheol, Rha Seung-Woon, Hwang Kyung-Kuk, Jung Kyung-Tae, Oh Seok-Kyu, Lee Jae-Hwan, Shin Eun-Seok, Kim Kee-Sik, Kim Hyo-Soo, Lim Do-Sun
机构信息
Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea.
Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea.
出版信息
Lipids Health Dis. 2016 Nov 18;15(1):197. doi: 10.1186/s12944-016-0374-5.
BACKGROUND
It is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus.
METHODS
A total of 984 AMI patients with diabetes mellitus from the DIabetic Acute Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were divided into two groups based on HDL-C level on admission: normal HDL-C group (HDL-C ≥ 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n = 465). The primary endpoint was 2-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR).
RESULTS
The median follow-up duration was 730 days. The 2-year MACE rates were significantly higher in the low HDL-C group than in the normal HDL-C group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p = 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p = 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of MACE compared to the normal HDL-C group (log-rank p = 0.013). After adjusting for conventional risk factors, Cox proportional hazards analysis suggested that low HDL-C was an independent risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval [CI] 1.034-9.144, p = 0.043).
CONCLUSIONS
In patients with diabetes mellitus, low HDL-C remained an independent risk predictor for MACE after adjusting for multiple risk factors during 2-year follow-up of AMI.
TRIAL REGISTRATION
This study was the sub-analysis of the prospective multi-center registry of DIAMOND (Diabetic acute myocardial infarction Disease) in Korea. This is the observational study supported by Bayer HealthCare, Korea. Study number is 15614. First patient first visit was 02 April 2010 and last patient last visit was 09 December 2013.
背景
目前尚不清楚低高密度脂蛋白胆固醇（HDL-C）是否会影响急性心肌梗死（AMI）后的心血管结局，尤其是糖尿病患者。
方法
来自韩国糖尿病急性心肌梗死疾病（DIAMOND）多中心注册研究的984例糖尿病AMI患者根据入院时的HDL-C水平分为两组：正常HDL-C组（HDL-C≥40mg/dL，n = 519）和低HDL-C组（HDL-C<40mg/dL，n = 465）。主要终点为2年主要不良心血管事件（MACE），定义为心脏死亡、非致命性心肌梗死（MI）和靶血管血运重建（TVR）的复合终点。
结果
中位随访时间为730天。低HDL-C组的2年MACE发生率显著高于正常HDL-C组（MACE，7.44%对3.49%，p = 0.006；心脏死亡，3.72%对0.97%，p = 0.004；非致命性MI，1.75%对1.55%，p = 0.806；TVR，3.50%对0.97%，p = 0.007）。Kaplan-Meier分析显示，低HDL-C组的MACE发生率显著高于正常HDL-C组（对数秩检验p = 0.013）。在调整传统危险因素后，Cox比例风险分析表明低HDL-C是MACE的独立风险预测因子（风险比[HR]3.075，95%置信区间[CI]1.034 - 9.144，p = 0.043）。
结论
在糖尿病患者中，在AMI的2年随访期间调整多个危险因素后，低HDL-C仍然是MACE的独立风险预测因子。
试验注册
本研究是韩国DIAMOND（糖尿病急性心肌梗死疾病）前瞻性多中心注册研究的亚分析。这是一项由韩国拜耳医疗保健公司支持的观察性研究。研究编号为15614。首例患者首次就诊时间为2010年4月2日，最后一例患者最后就诊时间为2013年12月9日。
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