Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Diseases; The Key Laboratory of Remodeling-related Cardiovascular Diseases, Ministry of Education; Beijing Municipal Key Laboratory of Clinical Epidemiology.
J Atheroscler Thromb. 2020 Jul 1;27(7):695-710. doi: 10.5551/jat.49841. Epub 2019 Oct 30.
A high-risk strategy has been implemented for lipid-lowering therapy in the primary prevention of cardiovascular disease. However, atherosclerosis and cardiovascular events are common among individuals with low cardiovascular risk. This study aimed to determine whether the small dense low-density lipoprotein cholesterol (sdLDLC) level can predict carotid atherosclerosis progression and identify high-risk individuals.
Baseline sdLDLC and low-density lipoprotein cholesterol (LDLC) were measured in 808 participants from the Chinese Multi-provincial Cohort Study, aged 45-74 years. Adjusted relative risk was calculated using a modified Poisson regression model to assess the relationship between sdLDLC and 5-year atherosclerosis progression, as indicated by the progression, incidence, and multi-territorial extent of carotid plaque.
The 5-year atherosclerosis progression increased significantly with increased sdLDLC. Baseline sdLDLC was significantly associated with the short-term risk of plaque progression after multivariable adjustment, even in participants with low LDLC or a 10-year estimated cardiovascular risk. sdLDLC predicted plaque progression (relative risk 2.05; 95% confidence interval 1.43-2.93) in participants with LDLC ＜130 mg/dL. Furthermore, participants with the highest sdLDLC but intermediate or low cardiovascular risk (accounting for 16% of the cohort) had double the risk of plaque progression, which was comparable to those with the same sdLDLC and high cardiovascular risk, relative to those with the lowest sdLDLC levels and low cardiovascular risk.
sdLDLC is independently associated with the progression of carotid atherosclerosis, which may provide a basis for clinicians to reclassify individuals believed to be at low cardiovascular risk into the high-risk category, and those with high sdLDLC may benefit from more aggressive cholesterol-lowering treatment.
在心血管疾病的一级预防中，已经实施了降脂治疗的高危策略。然而，低心血管风险个体中也常见动脉粥样硬化和心血管事件。本研究旨在确定小而密低密度脂蛋白胆固醇（sdLDLC）水平是否可以预测颈动脉粥样硬化进展并识别高危个体。
在来自中国多省份队列研究的 808 名年龄在 45-74 岁的参与者中，测量了基线 sdLDLC 和低密度脂蛋白胆固醇（LDLC）。使用修正泊松回归模型计算调整后的相对风险，以评估 sdLDLC 与颈动脉斑块进展、发生率和多部位程度等 5 年动脉粥样硬化进展之间的关系。
随着 sdLDLC 的增加，5 年动脉粥样硬化进展显著增加。基线 sdLDLC 与多变量调整后的斑块进展短期风险显著相关，即使在 LDLC ＜130mg/dL 或 10 年估计心血管风险低的参与者中也是如此。sdLDLC 预测了 LDLC＜130mg/dL 参与者的斑块进展（相对风险 2.05；95%置信区间 1.43-2.93）。此外，sdLDLC 最高但心血管风险中等或低（占队列的 16%）的参与者斑块进展的风险增加了一倍，与具有相同 sdLDLC 但心血管风险高的参与者相比，与 sdLDLC 最低且心血管风险低的参与者相比，风险相当。
sdLDLC 与颈动脉粥样硬化进展独立相关，这可能为临床医生提供依据，将被认为心血管风险低的个体重新归类为高危人群，而 sdLDLC 较高的个体可能从更积极的降脂治疗中获益。
