Cardiovascular Risk and Nutrition Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain; Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-Idibell, L'Hospitalet de Llobregat, Barcelona, Spain.
J Am Coll Cardiol. 2020 Dec 8;76(23):2712-2724. doi: 10.1016/j.jacc.2020.10.008.
Genetic, observational, and clinical intervention studies indicate that circulating levels of triglycerides and cholesterol transported in triglyceride-rich lipoproteins (remnant cholesterol) can predict cardiovascular events.
This study evaluated the association of triglycerides and remnant cholesterol (remnant-C) with major cardiovascular events in a cohort of older individuals at high cardiovascular risk.
This study determined the baseline lipid profile and searched for major adverse cardiovascular events (MACEs) in the high-risk primary prevention PREDIMED (Prevención con Dieta Mediterránea) trial population (mean age: 67 years; body mass index: 30 kg/m; 43% men; 48% with diabetes) after a median follow-up of 4.8 years. Unadjusted and adjusted Cox proportional hazard models were used to assess the association between lipid concentrations (either as continuous or categorical variables) and incident MACEs (N = 6,901; n cases = 263).
In multivariable-adjusted analyses, triglycerides (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.02 to 1.06, per 10 mg/dl [0.11 mmol/l]; p < 0.001), non-high-density lipoprotein cholesterol (HDL-C) (HR: 1.05; 95% CI: 1.01 to 1.10, per 10 mg/dl [0.26 mmol/l]; p = 0.026), and remnant-C (HR: 1.21; 95% CI: 1.10 to 1.33, per 10 mg/dl [0.26 mmol/l]; p < 0.001), but not low-density lipoprotein cholesterol (LDL-C) or HDL-C, were associated with MACEs. Atherogenic dyslipidemia (triglycerides >150 mg/dl [1.69 mmol/l] and HDL-C <40 mg/dl [1.03 mmol/l] in men or <50 mg/dl [1.29 mmol/l] in women) was also associated with MACEs (HR: 1.44; 95% CI: 1.04 to 2.00; p = 0.030). Remnant-C ≥30 mg/dl (0.78 mmol/l) differentiated subjects at a higher risk of MACEs compared with those at lower concentrations, regardless of whether LDL-C levels were on target at ≤100 mg/dl (2.59 mmol/l).
In overweight or obese subjects at high cardiovascular risk, levels of triglycerides and remnant-C, but not LDL-C, were associated with cardiovascular outcomes independent of other risk factors.
遗传、观察和临床干预研究表明，富含甘油三酯的脂蛋白（残余胆固醇）中运输的甘油三酯和胆固醇水平可以预测心血管事件。
本研究评估了在高心血管风险的老年人群中，甘油三酯和残余胆固醇（残余-C）与主要心血管事件的相关性。
本研究在高风险一级预防 PREDIMED（地中海饮食预防）试验人群（平均年龄：67 岁；体重指数：30kg/m；43%为男性；48%患有糖尿病）中确定了基线血脂谱，并在中位随访 4.8 年后搜索了主要不良心血管事件（MACEs）。使用未经调整和调整后的 Cox 比例风险模型评估脂质浓度（无论是连续变量还是分类变量）与新发 MACEs（N=6901；n 例=263）之间的关系。
在多变量调整分析中，甘油三酯（风险比 [HR]：1.04；95%置信区间 [CI]：1.02 至 1.06，每 10mg/dl [0.11mmol/l]；p<0.001）、非高密度脂蛋白胆固醇（HDL-C）（HR：1.05；95%CI：1.01 至 1.10，每 10mg/dl [0.26mmol/l]；p=0.026）和残余-C（HR：1.21；95%CI：1.10 至 1.33，每 10mg/dl [0.26mmol/l]；p<0.001），但不是低密度脂蛋白胆固醇（LDL-C）或 HDL-C，与 MACEs 相关。致动脉粥样硬化性血脂异常（男性甘油三酯>150mg/dl [1.69mmol/l]和 HDL-C<40mg/dl [1.03mmol/l]，女性甘油三酯>150mg/dl [1.69mmol/l]和 HDL-C<50mg/dl [1.29mmol/l]）也与 MACEs 相关（HR：1.44；95%CI：1.04 至 2.00；p=0.030）。与 LDL-C 水平在目标值<100mg/dl（2.59mmol/l）以下的患者相比，残余-C≥30mg/dl（0.78mmol/l）的患者发生 MACEs 的风险更高，无论其他危险因素如何。
在超重或肥胖且心血管风险高的人群中，甘油三酯和残余-C 水平与心血管结局相关，而 LDL-C 水平与其他风险因素无关。
