非他汀类药物使用者中低密度脂蛋白胆固醇水平低与死亡结局
Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users.
作者信息
Sung Ki-Chul, Huh Ji Hye, Ryu Seungho, Lee Jong-Young, Scorletti Eleonora, Byrne Christopher D, Kim Jang Young, Hyun Dae Sung, Ko Sang-Baek
机构信息
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
出版信息
J Clin Med. 2019 Oct 1;8(10):1571. doi: 10.3390/jcm8101571.
We aimed to test the association between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD), cancer, and all-cause mortality in non-statin users. A total of 347,971 subjects in Kangbuk Samsung Health Study (KSHS.57.4% men, mean follow up: 5.64 ± 3.27 years) were tested. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES, 182,943 subjects). All subjects treated with any lipid-lowering therapy and who died during the first 3 years of follow up were excluded. Five groups were defined according to baseline LDL-C concentration (<70, 70-99, 100-129, 130-159, ≥160 mg/dL). A total of 2028 deaths occurred during follow-up in KSHS. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55-2.47), CVD mortality (HR 2.02, 1.11-3.64), and cancer mortality (HR 2.06, 1.46-2.90) compared to the reference group (LDL 120-139 mg/dL). In the validation cohort, 2338 deaths occurred during follow-up. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44-2.28) compared to the reference group. Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD, and all-cause mortality. These findings suggest that more attention is needed for subjects with no statin-induced decrease in LDL-C concentrations.
我们旨在检验非他汀类药物使用者中低密度脂蛋白胆固醇(LDL-C)与心血管疾病(CVD)、癌症及全因死亡率之间的关联。对江北三星健康研究(KSHS,57.4%为男性,平均随访时间:5.64±3.27年)中的347,971名受试者进行了检测。为验证这些关联,我们分析了另一个队列(韩国基因组与流行病学研究,KoGES,182,943名受试者)的数据。排除了所有接受任何降脂治疗以及在随访的前3年期间死亡的受试者。根据基线LDL-C浓度(<70、70-99、100-129、130-159、≥160mg/dL)定义了五组。在KSHS随访期间共发生2028例死亡。与参照组(LDL 120-139mg/dL)相比,最低LDL-C组(LDL<70mg/dL)的全因死亡率(风险比[HR]1.95,1.55-2.47)、CVD死亡率(HR 2.02,1.11-3.64)和癌症死亡率(HR 2.06,1.46-2.90)更高。在验证队列中,随访期间发生2338例死亡。与参照组相比,最低LDL-C组(LDL<70mg/dL)的全因死亡率风险更高(HR 1.81,1.44-2.28)。低水平的LDL-C浓度与癌症、CVD及全因死亡率风险增加密切且独立相关。这些发现表明,对于LDL-C浓度未因他汀类药物而降低的受试者需要给予更多关注。