Zeng Li, Ye Ziwei, Li Ying, Zhou Yiling, Shi Qingyang, Hu Tao, Fu Minghuan, Wu Caojie, Tian Haoming, Li Sheyu
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Department of Geriatrics, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
Front Cardiovasc Med. 2021 Mar 16;8:638663. doi: 10.3389/fcvm.2021.638663. eCollection 2021.
Low-density lipoprotein cholesterol (LDL-C) is a critical surrogate outcome for cardiovascular disease (CVD). Recent observational studies identified different predictive lipid parameters, but these have not been fully validated in the Chinese population. This study aimed to compare the predictive value of lipid parameters for cardiovascular outcomes in Chinese statin-naïve patients who underwent percutaneous coronary intervention (PCI). We retrospectively recruited statin-naïve patients who underwent PCI for stable angina and acute coronary syndrome at Sichuan Provincial People's Hospital between 1 January 2016 and 31 December 2017. A follow-up was conducted via outpatient visits or telephone. We divided patients into three groups based on lipid parameter tertiles. We calculated the hazard ratios (HRs) of the highest and lowest tertiles for major adverse cardiovascular events (MACEs) using multivariate Cox proportional hazards regression. We compared the association strength of lipid parameters with MACEs using the HR of non-LDL-C lipid parameters relative to LDL-C. Among 445 included patients, the highest LDL-C, LDL-C/high-density lipoprotein cholesterol (HDL-C), atherosclerosis index, and non-HDL-C level tertiles were associated with an average increase of 165% (HR 2.65, confidence interval [CI] 1.26 to 5.61; = 0.01), 324% (HR 4.24, CI 1.89 to 9.52; < 0.001), 152% (HR 2.52, CI 1.22 to 5.22; = 0.01), and 125% (HR 2.25, CI 1.09 to 4.64; = 0.01) in the hazard of composite CVD, respectively. Lipoprotein (a) levels did not show a significant association with the endpoints. Except for LDL-C/HDL-C, different lipid parameter HR ratios were <1.0; none were statistically significant. Compared with non-LDL-C lipid parameters, LDL-C acts better predictive value for cardiovascular outcomes in general Chinese statin-naïve post-PCI patients.
低密度脂蛋白胆固醇（LDL-C）是心血管疾病（CVD）的关键替代结局指标。近期的观察性研究确定了不同的预测性血脂参数，但这些参数在中国人群中尚未得到充分验证。本研究旨在比较血脂参数对接受经皮冠状动脉介入治疗（PCI）的中国初治他汀类药物患者心血管结局的预测价值。我们回顾性招募了2016年1月1日至2017年12月31日期间在四川省人民医院因稳定型心绞痛和急性冠状动脉综合征接受PCI的初治他汀类药物患者。通过门诊就诊或电话进行随访。我们根据血脂参数三分位数将患者分为三组。我们使用多变量Cox比例风险回归计算主要不良心血管事件（MACE）最高和最低三分位数的风险比（HR）。我们使用非LDL-C血脂参数相对于LDL-C的HR比较血脂参数与MACE的关联强度。在纳入的445例患者中，LDL-C、LDL-C/高密度脂蛋白胆固醇（HDL-C）、动脉粥样硬化指数和非HDL-C水平最高三分位数与复合CVD风险平均分别增加165%（HR 2.65，置信区间[CI] 1.26至5.61；P = 0.01）、324%（HR 4.24，CI 1.89至9.52；P < 0.001）、152%（HR 2.52，CI 1.22至5.22；P = 0.01）和125%（HR 2.25，CI 1.09至4.64；P = 0.01）相关。脂蛋白（a）水平与终点无显著关联。除LDL-C/HDL-C外，不同血脂参数的HR比值<1.0；均无统计学意义。与非LDL-C血脂参数相比，LDL-C对一般中国初治PCI术后患者的心血管结局具有更好的预测价值。
