State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
J Lipid Res. 2020 Sep;61(9):1254-1262. doi: 10.1194/jlr.RA120000746. Epub 2020 Jul 8.
TG-rich lipoprotein (TRL)-related biomarkers, including TRL-cholesterol (TRL-C), remnant-like lipoprotein particle-cholesterol (RLP-C), and apoC-III have been associated with atherosclerosis. However, their prognostic values have not been fully determined, especially in patients with previous CAD. This study aimed to examine the associations of TRL-C, RLP-C, and apoC-III with incident cardiovascular events (CVEs) in the setting of secondary prevention of CAD. Plasma TRL-C, RLP-C, and total apoC-III were directly measured. A total of 4,355 participants with angiographically confirmed CAD were followed up for the occurrence of CVEs. During a median follow-up period of 5.1 years (interquartile range: 3.9-6.4 years), 543 (12.5%) events occurred. Patients with incident CVEs had significantly higher levels of TRL-C, RLP-C, and apoC-III than those without events. Multivariable Cox analysis indicated that a log unit increase in TRL-C, RLP-C, and apoC-III increased the risk of CVEs by 49% (95% CI: 1.16-1.93), 21% (95% CI: 1.09-1.35), and 40% (95% CI: 1.11-1.77), respectively. High TRL-C, RLP-C, and apoC-III were also independent predictors of CVEs in individuals with LDL-C levels ≤1.8 mmol/l (n = 1,068). The addition of RLP-C level to a prediction model resulted in a significant increase in discrimination, and all three TRL biomarkers improved risk reclassification. Thus, TRL-C, RLP-C, and apoC-III levels were independently associated with incident CVEs in Chinese CAD patients undergoing statin therapy.
富含 TG 的脂蛋白 (TRL)-相关生物标志物，包括 TRL 胆固醇 (TRL-C)、残粒样脂蛋白颗粒胆固醇 (RLP-C) 和载脂蛋白 C-III，与动脉粥样硬化有关。然而，它们的预后价值尚未完全确定，特别是在有既往 CAD 病史的患者中。本研究旨在探讨 TRL-C、RLP-C 和 apoC-III 与 CAD 二级预防患者发生心血管事件 (CVE) 的相关性。直接测量了血浆 TRL-C、RLP-C 和总 apoC-III。共纳入 4355 例经血管造影证实的 CAD 患者，随访 CVE 的发生情况。在中位随访时间为 5.1 年（四分位间距：3.9-6.4 年）期间，发生了 543 例（12.5%）事件。发生 CVE 的患者 TRL-C、RLP-C 和 apoC-III 水平明显高于未发生事件的患者。多变量 Cox 分析表明，TRL-C、RLP-C 和 apoC-III 每增加一个对数单位，CVE 的风险分别增加 49%（95%CI：1.16-1.93）、21%（95%CI：1.09-1.35）和 40%（95%CI：1.11-1.77）。在 LDL-C 水平≤1.8mmol/l（n=1068）的个体中，高 TRL-C、RLP-C 和 apoC-III 也是 CVE 的独立预测因素。将 RLP-C 水平添加到预测模型中可显著提高区分度，而所有三种 TRL 生物标志物均改善了风险再分类。因此，TRL-C、RLP-C 和 apoC-III 水平与接受他汀类药物治疗的中国 CAD 患者发生的 CVE 独立相关。
