Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510100, China.
Lipids Health Dis. 2021 Apr 19;20(1):36. doi: 10.1186/s12944-021-01460-6.
Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the "cholesterol paradox". Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.
A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition.
In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05-7.78 years]. Kaplan-Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).
This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition.
多项研究发现，急性冠状动脉综合征（ACS）患者的基线低密度脂蛋白胆固醇（LDL-C）浓度较低与预后不良相关，这被称为“胆固醇悖论”。较低的 LDL-C 浓度可能反映了潜在的营养不良，而营养不良与死亡率增加密切相关。本研究旨在探讨 CAD 患者中的胆固醇悖论以及营养不良的影响。
本研究纳入了 2007 年 1 月至 2018 年 12 月期间在中国广东省人民医院就诊的 41229 例 CAD 患者，将其分为两组（LDL-C＜1.8mmol/L，n=4863；LDL-C≥1.8mmol/L，n=36366）。采用 Kaplan-Meier 法和 Cox 回归分析评估 LDL-C 水平与长期全因死亡率的关系，以及营养不良的影响。
在这个真实世界的队列中（平均年龄 62.9 岁；74.9%为男性），中位随访 5.20 年[四分位距（IQR）：3.05-7.78 年]期间共有 5257 例患者发生全因死亡。Kaplan-Meier 分析显示，较低的 LDL-C 水平与预后较差相关。在校正基线混杂因素（如年龄、性别和合并症等）后，多变量 Cox 回归分析显示，低 LDL-C 水平（＜1.8mmol/L）与全因死亡率无显著相关性（调整后的 HR，1.04；95%CI，0.96-1.24）。在校正营养状况后，低 LDL-C 水平患者的全因死亡风险降低（调整后的 HR，0.90；95%CI，0.83-0.98）。在最终的多变量 Cox 模型中，低 LDL-C 水平与更好的预后相关（调整后的 HR，0.91；95%CI，0.84-0.99）。
本研究表明，CAD 患者中存在胆固醇悖论，但在考虑到营养不良的影响后该悖论消失。
