Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
Clin Chem. 2018 Jan;64(1):219-230. doi: 10.1373/clinchem.2017.279463. Epub 2017 Oct 11.
We tested whether high remnant cholesterol is associated with high myocardial infarction risk, independent of whether an individual is normal weight, overweight, or obese.
A total of 106216 individuals from the Copenhagen General Population Study were followed for up to 11 years, during which 1565 experienced a myocardial infarction. Individuals were grouped by clinically meaningful remnant cholesterol concentrations of <0.5 mmol/L (19 mg/dL), 0.5 to 0.99 mmol/L (19-38 mg/dL), 1.0 to 1.49 mmol/L (39-58 mg/dL), and ≥1.5 mmol/L (58 mg/dL), and by body mass index (BMI) of <18.5 kg/m (underweight), 18.5 to 24.9 kg/m (normal weight), 25 to 29.9 kg/m (overweight), and ≥30 kg/m (obese).
Median calculated remnant cholesterol was 0.40 mmol/L [interquartile range (IQR), 0.30-0.55 mmol/L] [15 mg/dL (12-21 mg/dL)] for underweight, 0.50 mmol/L (IQR, 0.37-0.71 mmol/L) [19 mg/dL (14-27 mg/dL)] for normal weight, 0.70 mmol/L (IQR, 0.49-1.00 mmol/L) [27 mg/dL (19-39 mg/dL)] for overweight, and 0.85 mmol/L (IQR, 0.61-1.20 mmol/L) [(33 mg/dL (24-46 mg/dL)] for obese individuals. On continuous scales, remnant cholesterol was positively correlated with BMI until reaching a plateau of approximately 1 mmol/L (39 mg/dL) at BMI >35 kg/m. from an unadjusted linear regression for the correlation between calculated remnant cholesterol and BMI was 12%. Stepwise higher remnant cholesterol was associated with stepwise higher myocardial infarction risk in a similar pattern for normal weight, overweight, and obese individuals. When compared with individuals with remnant cholesterol <0.5 mmol/L (19 mg/dL), individuals with remnant cholesterol ≥1.5 mmol/L (58 mg/dL) had hazard ratios for myocardial infarction of 2.0 (95% CI, 1.3-3.2) for normal weight, 1.9 (95% CI, 1.4-2.6) for overweight, and 2.3 (95% CI, 1.4-3.5) for obese individuals. Directly measured remnant cholesterol increased 0.91 mmol/L (95% CI, 0.89-0.94 mmol/L) [35 mg/dL (34-36 mg/dL)] per 1 mmol/L (39 mg/dL) increase in calculated remnant cholesterol.
Remnant cholesterol and BMI were positively correlated; however, high remnant cholesterol was associated with higher myocardial infarction risk across the examined BMI subcategories, indicating that remnant cholesterol is a risk factor for myocardial infarction independent of overweight and obesity.
我们检测了残余胆固醇水平升高是否与心肌梗死风险增加相关，而不论个体的体重指数（BMI）是否正常、超重或肥胖。
在长达 11 年的随访期间，共有 106216 名来自哥本哈根普通人群研究的个体经历了心肌梗死。个体根据有临床意义的残余胆固醇浓度分为<0.5 mmol/L（19 mg/dL）、0.5-0.99 mmol/L（19-38 mg/dL）、1.0-1.49 mmol/L（39-58 mg/dL）和≥1.5 mmol/L（58 mg/dL），并根据 BMI 分为<18.5 kg/m（体重不足）、18.5-24.9 kg/m（正常体重）、25-29.9 kg/m（超重）和≥30 kg/m（肥胖）。
体重不足个体的中位计算残余胆固醇为 0.40 mmol/L [四分位距（IQR），0.30-0.55 mmol/L] [15 mg/dL（12-21 mg/dL）]，正常体重个体为 0.50 mmol/L（IQR，0.37-0.71 mmol/L）[19 mg/dL（14-27 mg/dL）]，超重个体为 0.70 mmol/L（IQR，0.49-1.00 mmol/L）[27 mg/dL（19-39 mg/dL）]，肥胖个体为 0.85 mmol/L（IQR，0.61-1.20 mmol/L）[33 mg/dL（24-46 mg/dL）]。在连续量表上，残余胆固醇与 BMI 呈正相关，直至 BMI >35 kg/m 时达到约 1 mmol/L（39 mg/dL）的平台。从计算残余胆固醇与 BMI 之间的线性回归的未调整斜率来看，相关性为 12%。残余胆固醇水平逐渐升高与心肌梗死风险逐渐升高呈相似模式相关，无论个体的 BMI 为正常、超重还是肥胖。与残余胆固醇<0.5 mmol/L（19 mg/dL）的个体相比，残余胆固醇≥1.5 mmol/L（58 mg/dL）的个体发生心肌梗死的风险比分别为 2.0（95%CI，1.3-3.2）、1.9（95%CI，1.4-2.6）和 2.3（95%CI，1.4-3.5）。直接测量的残余胆固醇每增加 1 mmol/L（39 mg/dL），计算的残余胆固醇就会增加 0.91 mmol/L（95%CI，0.89-0.94 mmol/L）[35 mg/dL（34-36 mg/dL）]。
残余胆固醇与 BMI 呈正相关；然而，残余胆固醇升高与心肌梗死风险增加相关，且在检测的 BMI 亚组中，这表明残余胆固醇是心肌梗死的一个风险因素，独立于超重和肥胖。
