残余胆固醇对心血管风险的贡献。
Contribution of remnant cholesterol to cardiovascular risk.
机构信息
Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
出版信息
J Intern Med. 2020 Jul;288(1):116-127. doi: 10.1111/joim.13059. Epub 2020 Apr 7.
BACKGROUND
Remnant cholesterol in triglyceride-rich lipoproteins is associated observationally and genetic, causally with increased risk of atherosclerotic cardiovascular disease in healthy individuals.
OBJECTIVES
We tested the hypothesis that an unmet medical need exists in individuals with high nonfasting remnant cholesterol and prior atherosclerotic cardiovascular disease.
METHODS
From amongst 109 574 individuals in a prospective cohort study of the Danish general population, we included 2973 individuals aged 20-80 with baseline diagnoses of myocardial infarction/ischaemic stroke ascertained from national Danish health registries.
RESULTS
The recurrent major cardiovascular event (MACE) incidence rates per 1000 person-years were 39 (95% confidence interval: 30-50) for individuals with remnant cholesterol levels ≥ 1.5 mmol L (≥58 mg dL ), 31 (26-37) for 1-1.49 mmol L (39-57 mg dL ), 27 (24-31) for 0.5-0.99 mmol L (19-38 mg dL ) and 23 (19-27) for individuals with remnant cholesterol < 0.5 mmol L (<19 mg dL ). Compared to individuals with remnant cholesterol < 0.5 mmol L (<19 mg dL ), the subhazard ratio for recurrent MACE was 1.23 (95% CI: 0.98-1.55) for individuals with remnant cholesterol levels of 0.5-0.99 mmol L (19-38 mg dL ), 1.48 (1.14-1.92) for 1-1.49 mmol L (39-57 mg dL ) and 1.79 (1.28-2.49) for ≥ 1.5 mmol L (≥58 mg dL ). The recurrent MACE incidence rates per 1000 person-years for individuals with remnant cholesterol levels < 0.5 mmol L (<19 mg dL ) and ≥ 1.5 mmol L (≥58 mg dL ) were 10 (6.6-15) and 31 (21-47) for those below age 65 and correspondingly 25 (21-30) and 43 (32-59) for those with LDL cholesterol levels < 3 mmol L (<116 mg dL ), respectively. For a 20% recurrent MACE risk reduction in secondary prevention, an estimated remnant cholesterol lowering of 0.83 mmol L (32 mg dL ) would be needed.
CONCLUSIONS
In individuals with a diagnosis of myocardial infarction/ischaemic stroke, a lower remnant cholesterol of 0.8 mmol L (32 mg dL ) was estimated to reduce recurrent MACE by 20% in secondary prevention. Our data indicate an unmet medical need for secondary prevention in individuals with high nonfasting remnant cholesterol levels.
背景
富含甘油三酯的脂蛋白中的残余胆固醇与健康个体的动脉粥样硬化性心血管疾病风险增加存在观察性和因果关系。
目的
我们检验了这样一种假设，即在有高非空腹残余胆固醇和既往动脉粥样硬化性心血管疾病的个体中，存在未满足的医疗需求。
方法
在一项丹麦普通人群的前瞻性队列研究中，我们从全国丹麦健康登记处确定的基线诊断为心肌梗死/缺血性中风的 109574 名个体中，纳入了 2973 名年龄在 20-80 岁的个体。
结果
每 1000 人年的复发性主要心血管事件（MACE）发生率为：残余胆固醇水平≥1.5 mmol/L（≥58 mg/dL）者为 39（95%置信区间：30-50），1-1.49 mmol/L（39-57 mg/dL）者为 31（26-37），0.5-0.99 mmol/L（19-38 mg/dL）者为 27（24-31），残余胆固醇<0.5 mmol/L（<19 mg/dL）者为 23（19-27）。与残余胆固醇<0.5 mmol/L（<19 mg/dL）的个体相比，残余胆固醇水平为 0.5-0.99 mmol/L（19-38 mg/dL）的个体发生复发性 MACE 的亚危险比为 1.23（95%CI：0.98-1.55），1-1.49 mmol/L（39-57 mg/dL）者为 1.48（1.14-1.92），≥1.5 mmol/L（≥58 mg/dL）者为 1.79（1.28-2.49）。残余胆固醇<0.5 mmol/L（<19 mg/dL）和≥1.5 mmol/L（≥58 mg/dL）的个体每 1000 人年的复发性 MACE 发生率分别为 10（6.6-15）和 31（21-47），年龄<65 岁者分别为 25（21-30）和 43（32-59），LDL 胆固醇水平<3 mmol/L（<116 mg/dL）者分别为 25（21-30）和 43（32-59）。为了使二级预防中复发性 MACE 风险降低 20%，估计需要将残余胆固醇降低 0.83 mmol/L（32 mg/dL）。
结论
在诊断为心肌梗死/缺血性中风的个体中，估计残余胆固醇降低 0.8 mmol/L（32 mg/dL）可使二级预防中复发性 MACE 降低 20%。我们的数据表明，在高非空腹残余胆固醇水平的个体中，存在未满足的二级预防医疗需求。
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