State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing, 100037, China.
Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Cardiovasc Diabetol. 2020 Sep 27;19(1):152. doi: 10.1186/s12933-020-01125-1.
Recent guidelines highlighted the association between atherosclerosis and triglyceride-enriched lipoproteins in patients with impaired glucose metabolism. However, evidence from prospective studies for long-term prognostic utility of low-density lipoprotein triglyceride (LDL-TG) in real-world patients with prediabetes (Pre-DM) or diabetes mellitus (DM) and coronary artery disease (CAD) is currently not available. The aim of the present study was to evaluate the impact of LDL-TG on major adverse cardiovascular events (MACEs) in patients with stable CAD under different glucose metabolism status.
A total of 4381 patients with CAD were consecutively enrolled and plasma LDL-TG level was measured by an automated homogeneous assay. They were categorized according to both status of glucose metabolism [DM, Pre-DM, normal glycaemia regulation (NGR)] and tertiles of LDL-TG. All subjects were followed up for the occurrence of MACEs.
During a median of 5.1 (interquartile range 3.9 to 5.9) years' follow-up, 507 (11.6%) MACEs occurred. Cubic spline models showed a significant association between LDL-TG and MACEs in DM and Pre-DM but not in NGR. When the combined effect of elevated LDL-TG and glucose disorders was considered for risk stratification, the medium tertile of LDL-TG plus DM, and the highest tertile of LDL-TG plus Pre-DM or plus DM subgroups were associated with significantly higher risk of MACEs after adjustment of confounders including triglyceride [hazard ratios (95% confidence intervals): 1.843 (1.149-2.955), 1.828 (1.165-2.867), 2.212 (1.396-3.507), all p < 0.05]. Moreover, adding LDL-TG into the original model increased the C-statistic from 0.687 to 0.704 (∆C-statistic = 0.016, p = 0.028) and from 0.734 to 0.749 (∆C-statistic = 0.014, p = 0.002) in Pre-DM and DM, respectively.
In this longitudinal cohort study on real-world practice, higher LDL-TG was associated with worse outcomes among Pre-DM and DM patients with stable CAD.
最近的指南强调了动脉粥样硬化与葡萄糖代谢受损患者富含甘油三酯的脂蛋白之间的关联。然而，目前尚无前瞻性研究证据表明低密度脂蛋白甘油三酯（LDL-TG）在患有前驱糖尿病（Pre-DM）或糖尿病（DM）和冠心病（CAD）的现实世界患者中的长期预后价值。本研究旨在评估不同葡萄糖代谢状态下稳定 CAD 患者 LDL-TG 对主要不良心血管事件（MACEs）的影响。
连续纳入 4381 例 CAD 患者，通过自动化均相测定法测量血浆 LDL-TG 水平。根据葡萄糖代谢状态[DM、Pre-DM、正常血糖调节（NGR）]和 LDL-TG 的三分位值对其进行分类。所有患者均进行 MACEs 的随访。
在中位数为 5.1 年（四分位距 3.9 至 5.9 年）的随访期间，发生了 507 例（11.6%）MACEs。三次样条模型显示，LDL-TG 与 DM 和 Pre-DM 患者的 MACEs 之间存在显著关联，但在 NGR 患者中不存在。当考虑升高的 LDL-TG 和葡萄糖紊乱的联合作用进行风险分层时，LDL-TG 中值三分位加上 DM，以及 LDL-TG 最高三分位加上 Pre-DM 或加上 DM 亚组在调整了包括甘油三酯在内的混杂因素后，与 MACEs 的风险显著增加相关[危险比（95%置信区间）：1.843（1.149-2.955）、1.828（1.165-2.867）、2.212（1.396-3.507），均 P<0.05]。此外，将 LDL-TG 加入原始模型后，DM 患者的 C 统计量从 0.687 增加到 0.704（ΔC 统计量=0.016，P=0.028），Pre-DM 患者从 0.734 增加到 0.749（ΔC 统计量=0.014，P=0.002）。
在这项真实世界实践的纵向队列研究中，较高的 LDL-TG 与稳定 CAD 的前驱糖尿病和糖尿病患者的预后不良相关。
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