Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Division of Vascular Surgery, National-Local Joint Engineering Laboratory of Vascular Disease Treatment, Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangdong Engineering Laboratory of Diagnosis and Treatment of Vascular Disease, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
Nutr Metab Cardiovasc Dis. 2021 Feb 8;31(2):570-578. doi: 10.1016/j.numecd.2020.10.008. Epub 2020 Oct 19.
Glucose and lipid metabolism are major prognostic indicators of coronary heart disease. The ratio of plasma glycosylated hemoglobin A1c (HbA1c) to apolipoprotein A-l (ApoA-l) is an indirect measure of insulin resistance. The study aimed to evaluate whether the HbA1c/ApoA-1 ratio can predict the prognosis in patients with the acute coronary syndrome (ACS).
A total of 476 ACS patients diagnosed by coronary angiography were enrolled in this longitudinal, observational, retrospective study. Plasma HbA1c, fasting blood glucose and lipid profile were measured. Patients were stratified according to the tertiles of HbA1c/ApoA-l levels. Cox proportional hazard model was used to examine the predictive value of HbA1c/ApoA-l for study endpoints. The association between the Log HbA1c/ApoA-l ratio and major adverse cardiovascular events (MACEs) was estimated using multiple logistic regression. Baseline characteristics showed a mean age of 66 ± 8 years, and 52.5% were hypertensive, 26.8% diabetic, and 54.5% current or prior smokers. During a mean follow-up period of 22.3 ± 1.7 months, 59 deaths occurred. After adjusting for age, gender, smoking, hypertension, diabetes, and coronary artery disease severity, patients in the highest HbA1c/ApoA-l ratio tertile had a 4.36-fold increased risk of mortality compared with those in the lowest tertile. The multivariate logistic regression showed that the Log HbA1c/ApoA-l ratio was associated with MACEs (Odds ratio 2.95, p = 0.013).
After adjusting for traditional cardiovascular risk factors and ACS severity scores, the HbA1c/ApoA-1 ratio remained an independent predictor of all-cause mortality and MACEs in the ACS patients undergoing angiography.
血糖和脂代谢是冠心病的主要预后指标。血浆糖化血红蛋白 A1c（HbA1c）与载脂蛋白 A-l（ApoA-l）的比值是间接衡量胰岛素抵抗的指标。本研究旨在评估 HbA1c/ApoA-1 比值是否可预测急性冠脉综合征（ACS）患者的预后。
这项纵向、观察性、回顾性研究共纳入了 476 例经冠状动脉造影诊断为 ACS 的患者。测定了患者的血浆 HbA1c、空腹血糖和血脂谱。根据 HbA1c/ApoA-l 水平的三分位将患者分层。使用 Cox 比例风险模型来检查 HbA1c/ApoA-l 对研究终点的预测价值。使用多因素逻辑回归来估计 Log HbA1c/ApoA-l 比值与主要不良心血管事件（MACE）之间的关系。基线特征显示平均年龄为 66±8 岁，52.5%为高血压患者，26.8%为糖尿病患者，54.5%为当前或既往吸烟者。在平均 22.3±1.7 个月的随访期间，有 59 例死亡。在校正年龄、性别、吸烟、高血压、糖尿病和冠状动脉疾病严重程度后，HbA1c/ApoA-l 比值最高三分位的患者死亡风险比最低三分位的患者高 4.36 倍。多因素逻辑回归显示 Log HbA1c/ApoA-l 比值与 MACE 相关（比值比 2.95，p=0.013）。
在校正传统心血管危险因素和 ACS 严重程度评分后，HbA1c/ApoA-1 比值仍然是接受血管造影的 ACS 患者全因死亡率和 MACE 的独立预测因素。
