经皮冠状动脉介入治疗后随访 LDL、HDL 和非 HDL-胆固醇变异性对死亡率和心血管结局的影响。

Effect of visit-to-visit LDL-, HDL-, and non-HDL-cholesterol variability on mortality and cardiovascular outcomes after percutaneous coronary intervention.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

出版信息

Atherosclerosis. 2018 Dec;279:1-9. doi: 10.1016/j.atherosclerosis.2018.10.012. Epub 2018 Oct 17.

DOI:10.1016/j.atherosclerosis.2018.10.012

PMID:30359786

Abstract

BACKGROUND AND AIMS

Visit-to-visit variability in biological measures has been suggested as an independent predictor of cardiovascular disease (CVD). Although low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) are important risk factors of CVD, there are few studies investigating the effect of variability in LDL-C and HDL-C on cardiovascular outcomes. We investigated the association between visit-to-visit variability in LDL-C, HDL-C, and non-HDL-C and major adverse cardiovascular and cerebrovascular events (MACCE) in patients who underwent percutaneous coronary intervention (PCI).

METHODS

Data from 1792 subjects who underwent PCI from January 2004 to December 2009 were analyzed. Visit-to-visit variability was calculated using various indices: standard deviation (SD), coefficient of variation, and corrected variability independent of mean (cVIM). MACCE comprised all-cause death, non-fatal myocardial infarction, and stroke.

RESULTS

During a median follow-up period of 65 months, 114 subjects (6.4%) experienced MACCE: 68 (3.8%) all-cause death; 43 (2.4%) stroke, and 15 (0.8%) non-fatal myocardial infarction. Visit-to-visit variability in LDL-C, HDL-C, and non-HDL-C was significantly higher in the MACCE group compared to the non-MACCE group. In multiple regression analysis, all LDL-C, HDL-C, and non-HDL-C variability parameters were independent predictors for MACCE after adjusting for potential confounding factors. Each 1-SD increase of cVIM in LDL-C, HDL-C, and non-HDL-C increased the risk of MACCE by 34% (HR 1.34 [95% CI, 1.18-1.52]), 50% (HR 1.50 [95% CI 1.32-1.71]), and 37% (HR 1.37 [95% CI, 1.20-1.57]), respectively. These relationships were observed in various subgroups according to age, sex, and diabetes status.

CONCLUSIONS

Visit-to-visit variability in LDL-C, HDL-C, and non-HDL-C is associated with MACCE in subjects with previous PCI.

摘要

背景和目的

生物标志物的变异性已经被认为是心血管疾病（CVD）的独立预测因子。虽然低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）是 CVD 的重要危险因素，但很少有研究调查 LDL-C 和 HDL-C 变异性对心血管结局的影响。我们研究了经皮冠状动脉介入治疗（PCI）患者 LDL-C、HDL-C 和非 HDL-C 的变异性与主要不良心血管和脑血管事件（MACCE）之间的关系。

方法

分析了 2004 年 1 月至 2009 年 12 月接受 PCI 的 1792 例患者的数据。使用标准差（SD）、变异系数和校正平均独立变异系数（cVIM）等各种指数计算变异性。MACCE 包括全因死亡、非致死性心肌梗死和卒中。

结果

在中位数为 65 个月的随访期间，114 例患者（6.4%）发生 MACCE：68 例（3.8%）全因死亡；43 例（2.4%）卒中，15 例（0.8%）非致死性心肌梗死。MACCE 组的 LDL-C、HDL-C 和非 HDL-C 的变异性明显高于非 MACCE 组。在多变量回归分析中，在调整潜在混杂因素后，所有 LDL-C、HDL-C 和非 HDL-C 变异性参数均为 MACCE 的独立预测因子。LDL-C、HDL-C 和非 HDL-C 的 cVIM 每增加 1-SD，MACCE 的风险分别增加 34%（HR 1.34 [95%CI，1.18-1.52]）、50%（HR 1.50 [95%CI，1.32-1.71]）和 37%（HR 1.37 [95%CI，1.20-1.57]）。根据年龄、性别和糖尿病状态，在各种亚组中观察到这些关系。