Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino).
Department of Biostatistics, Biosciences Institute, São Paulo State University, Av Rubião Jr.-Centro, Botucatu-SP, 18618-970 Botucatu, São Paulo, Brazil (Liciana V.A. Silveira).
Nutr Metab Cardiovasc Dis. 2020 Oct 30;30(11):2093-2102. doi: 10.1016/j.numecd.2020.07.002. Epub 2020 Jul 10.
Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs).
Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L).
RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.
心血管疾病（CVDis）是发病率和死亡率的主要原因。即使在引入降低胆固醇的药物治疗后，仍存在残余风险，这可能归因于残余胆固醇（RC）。我们旨在通过分析两项前瞻性队列研究，估计 RC 对心血管死亡（CVDs）风险和危害的影响，同时考虑到癌症（CDs）和其他原因死亡（OCDs）等竞争风险。
队列于 1992 年和 2005 年招募。记录个人数据历史。采集空腹静脉血样，并在基线时计算 RC。死因采用 ICD-10 版本进行编码。随访于 2017 年 12 月 31 日结束。应用灵活参数竞争风险模型，以死亡时的年龄为时间轴。共纳入 5729 名受试者。有 861 人（15.1%）死亡：234 例 CVDs（27.2%），245 例 CDs（28.5%），271 例 OCDs（31.5%）和 111 例死因不明（12.8%）。RC 暴露仅强烈预测 CVDs 的风险（风险 2.54，95%置信区间 1.21；5.34；趋势 1.26（1.00；1.58），≥1.29mmol/L）。
RC 是心血管死亡率的一个强有力的独立危险因素。竞争风险分析显然是一种有用的工具，可以理清具有共同危险因素的不同竞争事件之间的关联。
