Li Huanqiang, Wang Bo, Mai Ziling, Yu Sijia, Zhou Ziyou, Lu Hongyu, Lai Wenguang, Li Qiang, Yang Yongquan, Deng Jingru, Tan Ning, Chen Jiyan, Liu Jin, Liu Yong, Chen Shiqun
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Cardiovasc Med. 2022 Jan 25;9:822626. doi: 10.3389/fcvm.2022.822626. eCollection 2022.
Apolipoprotein B (ApoB) and low-density lipoprotein cholesterol (LDL-C) were identified targets for blood lipid management among coronary artery disease (CAD) patients. However, previous studies reported an inverse correlation between baseline LDL-C concentration and clinical outcomes. This study aims to explore the definite association between baseline ApoB and long-term prognosis.
A total of 36,460 CAD patients admitted to Guangdong Provincial People's Hospital were enrolled and categorized into two groups: high ApoB (≥65 mg/dL) group and low ApoB (<65 mg/dL) group. The association between baseline ApoB and long-term all-cause mortality was evaluated by the Kaplan-Meier method, Cox regression analyses and restricted cubic splines.
The overall mortality was 12.49% ( = 4,554) over a median follow-up period of 5.01 years. Patients with low baseline ApoB levels were paradoxically more likely to get a worse prognosis. There was no obvious difference in risk of long-term all-cause mortality when only adjusted for age, gender, and comorbidity (aHR: 1.07, 95% CI: 0.99-1.16). When CONUT and total bilirubin were adjusted, the risk of long-term all-cause mortality would reduce in the low-ApoB (<65 mg/dL) group (aHR: 0.86, 95% CI: 0.78-0.96). In the fully covariable-adjusted model, patients in the ApoB <65 mg/d group had a 10.00% lower risk of long-term all-cause mortality comparing to patients with ApoB ≥65 mg/dL (aHR: 0.90; 95% CI:0.81-0.99).
This study found a paradoxical association between baseline ApoB and long-term all-cause mortality. Malnutrition and bilirubin mainly mediate the ApoB paradox. Increased ApoB concentration remained linearly associated with an increased risk of long-term all-cause mortality.
载脂蛋白B（ApoB）和低密度脂蛋白胆固醇（LDL-C）被确定为冠状动脉疾病（CAD）患者血脂管理的目标。然而，先前的研究报告了基线LDL-C浓度与临床结局之间呈负相关。本研究旨在探讨基线ApoB与长期预后之间的确切关联。
总共纳入了36460名入住广东省人民医院的CAD患者，并将其分为两组：高ApoB（≥65mg/dL）组和低ApoB（<65mg/dL）组。采用Kaplan-Meier法、Cox回归分析和受限立方样条评估基线ApoB与长期全因死亡率之间的关联。
在中位随访期5.01年期间，总体死亡率为12.49%（n = 4554）。基线ApoB水平低的患者反而更有可能预后较差。仅调整年龄、性别和合并症时，长期全因死亡风险无明显差异（校正后风险比：1.07，95%置信区间：0.99-1.16）。调整CONUT和总胆红素后，低ApoB（<65mg/dL）组的长期全因死亡风险会降低（校正后风险比：0.86，95%置信区间：0.78-0.96）。在完全协变量调整模型中，与ApoB≥65mg/dL的患者相比，ApoB<65mg/d组的患者长期全因死亡风险低%（校正后风险比：0.90；95%置信区间：0.81-0.99）。
本研究发现基线ApoB与长期全因死亡率之间存在矛盾的关联。营养不良和胆红素主要介导ApoB矛盾现象。ApoB浓度升高与长期全因死亡风险增加仍呈线性相关。
