Key Laboratory of Cellular Physiology, Ministry of Education, and the Department of Physiology, Shanxi Medical University, Taiyuan, Shanxi Province, China.
The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
Am J Hypertens. 2021 Nov 20;34(11):1209-1216. doi: 10.1093/ajh/hpab105.
Plasma ceramides (Cer) have been used to evaluate risk of cardiovascular (CV) events in patients with coronary heart disease. We investigated the performance of ceramides and ceramide score (CERT) in hypertensive patients at high CV risk.
Seven ceramides were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry in 920 essential hypertension patients at high CV risk, who visited Beijing Anzhen Hospital from September 2016 to September 2018 (median age: 49 years, 562 males). All patients were followed up for major adverse cardiovascular events (MACE), which included incident acute coronary syndrome, heart failure, stroke, and CV death.
During mean 2.3-year follow-up, 71 patients experienced MACE. Cer(d18:1/16:0), Cer(d18:1/22:0), and Cer(d18:1/24:0) were highly significant in predicting MACE [multiadjusted hazard ratios (95% confidence interval, CI) per SD were 1.76 (1.34-2.30), 0.55 (0.41-0.73), and 0.66 (0.47-0.92), respectively]. Compared with traditional variables (comprising presence of CV risk factors, hypertension-mediated organ damage, and comorbidities), a novel CERT for hypertensive patients (CERT-HBP), composed of Cer(d18:1/16:0), Cer(d18:1/24:1), and their ratios to Cer(d18:1/24:0) and Cer(d18:1/22:0), respectively, increased the C-statistic from 0.751 (95% CI, 0.697-0.806) to 0.791 (95% CI, 0.737-0.845), P = 0.010. Net reclassification improvement and integrated discrimination improvement were 0.648 (95% CI, 0.421-0.885, P < 0.001) and 0.046 (95% CI, 0.025-0.068, P < 0.001), respectively.
A ceramide-based CERT-HBP was established to evaluate risk of MACE in hypertensive patients at high CV risk. This may improve identification of high-risk patients requiring increased attention and aggressive therapy.
Trial Number NCT03708601.
血浆神经酰胺（Cer）已被用于评估冠心病患者发生心血管（CV）事件的风险。我们研究了神经酰胺和神经酰胺评分（CERT）在高血压高 CV 风险患者中的表现。
在 2016 年 9 月至 2018 年 9 月期间，920 名患有高血压高 CV 风险的患者在北京安贞医院接受了超高效液相色谱-串联质谱分析，以分析 7 种神经酰胺（中位年龄：49 岁，562 名男性）。所有患者均进行了主要不良心血管事件（MACE）的随访，包括急性冠状动脉综合征、心力衰竭、中风和心血管死亡的发生。
在平均 2.3 年的随访期间，71 名患者发生了 MACE。Cer(d18:1/16:0)、Cer(d18:1/22:0)和 Cer(d18:1/24:0)在预测 MACE 方面具有显著意义[每 SD 的多调整危险比（95%置信区间，CI）分别为 1.76（1.34-2.30）、0.55（0.41-0.73）和 0.66（0.47-0.92）]。与传统变量（包括 CV 危险因素、高血压介导的器官损伤和合并症）相比，由 Cer(d18:1/16:0)、Cer(d18:1/24:1)和它们与 Cer(d18:1/24:0)和 Cer(d18:1/22:0)的比值组成的新型高血压患者 CERT（CERT-HBP）增加了 C 统计量从 0.751（95%CI，0.697-0.806）到 0.791（95%CI，0.737-0.845），P=0.010。净重新分类改善和综合判别改善分别为 0.648（95%CI，0.421-0.885，P<0.001）和 0.046（95%CI，0.025-0.068，P<0.001）。
建立了基于神经酰胺的 CERT-HBP 来评估高血压高 CV 风险患者的 MACE 风险。这可能有助于识别需要更多关注和强化治疗的高危患者。
试验编号 NCT03708601。
