非高密度脂蛋白胆固醇悖论及潜在营养不良对冠心病患者的影响：一项41,182例队列研究。
Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study.
作者信息
Wang Bo, Guo Zhaodong, Li Huanqiang, Zhou Ziyou, Lu Hongyu, Ying Ming, Mai Ziling, Yu Yaren, Yang Yongquan, Deng Jingru, Chen Jiyan, Tan Ning, Liu Jin, Liu Yong, Chen Shiqun
机构信息
Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; 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.
Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, 518020, Guangdong, China.
出版信息
Clin Nutr. 2022 Mar;41(3):723-730. doi: 10.1016/j.clnu.2022.01.027. Epub 2022 Feb 6.
BACKGROUND & AIMS: Non-high-density lipoprotein cholesterol (non-HDL-C) and low-density lipoprotein cholesterol (LDL-C) were established as the target for blood lipid management among patients with coronary artery disease (CAD). Previous study reported a negative relation between baseline LDL-C levels and long-term prognosis. However, the association between baseline non-HDL-C concentration and clinical outcomes is unknown.
METHODS
A total of 41,182 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 (non-HDL-C < 2.2 mmol/L, n = 3236; non-HDL-C ≥ 2.2 mmol/L, n = 37,946). The Kaplan-Meier method, Cox regression analyses and restricted cubic splines were used to assess the association between non-HDL-C levels and long-term all-cause mortality.
RESULTS
The overall mortality was 12.74% (n = 5247) over a median follow-up period of 5.20 years. Kaplan-Meier analysis showed that low non-HDL-C levels were paradoxically associated with a worse prognosis. After adjustment for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low non-HDL-C levels (<2.2 mmol/L) were not significantly associated with all-cause mortality (adjusted HR, 1.03; 95% CI, 0.93-1.14). After adjustment for nutritional status, the risk of all-cause mortality in patients with low non-HDL-C levels decreased (adjusted HR, 0.86; 95% CI, 0.78-0.95). In the final multivariate Cox model adjusting for full covariates, low non-HDL-C level was related to better prognosis (adjusted HR, 0.88; 95% CI, 0.80-0.98).
CONCLUSION
This study found a paradoxical association between baseline non-HDL-C concentration and long-term all-cause mortality. Malnutrition mainly mediates to the non-HDL-C paradox. Elevated non-HDL-C concentration is still a risk factor of long-term all-cause mortality after considering nutritional status.
背景与目的
非高密度脂蛋白胆固醇（non-HDL-C）和低密度脂蛋白胆固醇（LDL-C）已被确立为冠状动脉疾病（CAD）患者血脂管理的目标。既往研究报道了基线LDL-C水平与长期预后之间的负相关关系。然而，基线非HDL-C浓度与临床结局之间的关联尚不清楚。
方法
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住院的41182例CAD患者，并将其分为两组（非HDL-C < 2.2 mmol/L，n = 3236；非HDL-C≥2.2 mmol/L，n = 37946）。采用Kaplan-Meier法、Cox回归分析和限制性立方样条法评估非HDL-C水平与长期全因死亡率之间的关联。
结果
在中位随访期5.20年期间，总体死亡率为12.74%（n = 5247）。Kaplan-Meier分析显示，低非HDL-C水平与较差的预后呈矛盾相关。在对基线混杂因素（如年龄、性别和合并症等）进行调整后，多因素Cox回归分析显示，低非HDL-C水平（<2.2 mmol/L）与全因死亡率无显著关联（调整后HR，1.03；95%CI，0.93 - 1.14）。在对营养状况进行调整后，低非HDL-C水平患者的全因死亡风险降低（调整后HR，0.86；95%CI，0.78 - 0.95）。在最终调整了全部协变量的多因素Cox模型中，低非HDL-C水平与较好的预后相关（调整后HR，0.88；95%CI，0.80 - 0.98）。
结论
本研究发现基线非HDL-C浓度与长期全因死亡率之间存在矛盾关联。营养不良主要介导了非HDL-C矛盾现象。在考虑营养状况后，升高的非HDL-C浓度仍是长期全因死亡的危险因素。
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