Liu Xinmin, Wang Yu, Wu Jianwei, Wang Anxin, Zhang Xiaoli, Cao Zhentang, Zhao Xingquan
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Front Neurol. 2021 Oct 21;12:696695. doi: 10.3389/fneur.2021.696695. eCollection 2021.
Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis with increased risk of severe cardiovascular and cerebrovascular events. The relationship between one-time measuring of low-density lipoprotein cholesterol (LDL-C) and PAD is inconsistent. Increasing evidence shows that the predictive value of non-high-density lipoprotein cholesterol (non-HDLC) on atherosclerosis disease is superior to LDL-C. We aimed to investigate the relationship between cumulative exposure to increased LDL-C and the risk of newly developed PAD and compare the predictive value of LDL-C with non-HDLC. In the Asymptomatic Polyvascular Abnormalities Community study, we enrolled 2,923 participants with LDL-C and non-HDLC measured every 2 years from 2006 to 2012. Cumulative exposure to increased LDL-C and non-HDLC, defined as LDL-C burden and non-HDLC burden, respectively, was calculated as the weighted sum of the difference between the measured value and the cutoff value. A new occurrence of PAD was identified through ankle brachial index measured in 2010 and 2012. Multivariate models were adopted to analyze the association of LDL-C burden and non-HDLC burden with the newly developed PAD. The receiver operating curve was drawn, and the area under the curve was calculated to compare the predictive performance of LDL-C burden with a single measure of LDL-C in 2006 and non-HDL-C burden adjusted with a model including traditional risk factors. Of the 2,923 participants, 5.4% (158/2,923) were diagnosed as newly developed PAD. In the univariate analysis, the highest quartile of LDL-C burden was significantly associated with new occurrence of PAD [odds ratio (OR) 1.75, 95% confidence interval (CI) 1.13-2.73]. After adjustment for confounding factors, the same result was obtained (OR 1.59, 95%CI 1.01-2.49). The non-HDLC burden failed to show any statistical significance on the newly developed PAD (OR 1.31, 95% CI 0.84-2.04). Though LDL-C burden had a tendency to show better predictive performance than non-HDLC, it did not reach statistical significance (AUC = 0.554 . AUC = 0.544, = 0.655). Cumulative exposure to increased LDL-C is an independent risk factor of newly developed PAD. The predictive value of non-HDLC burden was not revealed.
外周动脉疾病（PAD）是全身动脉粥样硬化的一种表现，会增加严重心血管和脑血管事件的风险。一次性测量低密度脂蛋白胆固醇（LDL-C）与PAD之间的关系并不一致。越来越多的证据表明，非高密度脂蛋白胆固醇（non-HDLC）对动脉粥样硬化疾病的预测价值优于LDL-C。我们旨在研究累积暴露于升高的LDL-C与新发生PAD的风险之间的关系，并比较LDL-C与non-HDLC的预测价值。在无症状多血管异常社区研究中，我们纳入了2923名参与者，他们在2006年至2012年期间每2年测量一次LDL-C和non-HDLC。累积暴露于升高的LDL-C和non-HDLC，分别定义为LDL-C负担和non-HDLC负担，计算为测量值与临界值之差的加权和。通过2010年和2012年测量的踝臂指数确定新发生的PAD。采用多变量模型分析LDL-C负担和non-HDLC负担与新发生的PAD之间的关联。绘制受试者工作曲线，并计算曲线下面积，以比较LDL-C负担与2006年单次测量的LDL-C以及用包括传统危险因素的模型调整后的non-HDL-C负担的预测性能。在2923名参与者中，5.4%（158/2923）被诊断为新发生的PAD。在单变量分析中，LDL-C负担的最高四分位数与新发生的PAD显著相关[比值比（OR）1.75，95%置信区间（CI）1.13 - 2.73]。在调整混杂因素后，得到了相同的结果（OR 1.59，95%CI 1.01 - 2.49）。non-HDLC负担对新发生的PAD未显示出任何统计学意义（OR 1.31，95%CI 0.84 - 2.04）。尽管LDL-C负担显示出比non-HDLC更好地预测性能的趋势，但未达到统计学意义（AUC = 0.554，AUC = 0.544，P = 0.655）。累积暴露于升高的LDL-C是新发生PAD的独立危险因素。未揭示non-HDLC负担的预测价值。
