Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiovasc Diabetol. 2022 Feb 22;21(1):29. doi: 10.1186/s12933-022-01459-y.
Non-diabetic coronary artery disease (CAD) patients are thought to encounter metabolic dysfunction and while these changes may be imperceptible to the patient they probably influence outcomes. At present, there is no system to support patients sensing these subtle changes, nor is there an established model for prognoses. The Atherogenic Index of Plasma (AIP) index has already proven useful for atherosclerosis although further research is needed, especially for those without hyperglycemia.
This is a prospective study of 5538 non-diabetic CAD patients who had received percutaneous coronary intervention (PCI). Participants were assigned to one of three groups according to their AIP index. High AIP index cases were then compared to low index patients according to major adverse cardiac events (MACE). Restricted cubic spline (RCS) analysis was also conducted to investigate interrelations between AIP index levels and hazard ratios (HR) for MACEs.
Patients with a high AIP index encountered metabolic dysfunction compared to those with a low AIP index i.e., higher Body Mass Index (BMI), Total Cholesterol (TC), Triglycerides (TG), and uric acid as well as lower HDL-C. Each of the aforementioned interrelations were significant with p values of less than 0.001. There was also a significant increase in the number of MACEs in the high AIP index group compared to the low AIP index group (HR: 1.37, 95% CI 1.04-1.81; p = 0.025). A J-shaped RCS curve highlighted a change in the HR after the 0.18 juncture (HR per SD: 1.20, 95% CI 0.96-1.50). Further subgroup analysis supported the main findings, all with HRs greater than one.
The AIP index could be used in prognostics for non-diabetic CAD patients 2 years after PCI. The relationship between hazard ratio and the AIP index appears to be J-shaped. Although, further multi-center studies designed for non-diabetic patients with potential metabolic dysfunction should be conducted to determine the value of the AIP index.
非糖尿病性冠状动脉疾病 (CAD) 患者被认为会遇到代谢功能障碍，尽管这些变化可能对患者来说难以察觉，但它们可能会影响预后。目前，尚无系统支持患者感知这些细微变化，也没有确立用于预测的模型。载脂蛋白指数 (AIP) 指数已被证明对动脉粥样硬化有用，但还需要进一步研究，尤其是对那些没有高血糖的患者。
这是一项对 5538 名接受经皮冠状动脉介入治疗 (PCI) 的非糖尿病性 CAD 患者的前瞻性研究。根据 AIP 指数将参与者分为三组。然后根据主要不良心脏事件 (MACE) 将高 AIP 指数病例与低指数患者进行比较。限制性立方样条 (RCS) 分析也用于研究 AIP 指数水平与 MACE 危险比 (HR) 之间的关系。
与 AIP 指数低的患者相比，AIP 指数高的患者发生代谢功能障碍，即体重指数 (BMI)、总胆固醇 (TC)、甘油三酯 (TG) 和尿酸较高，高密度脂蛋白胆固醇 (HDL-C) 较低。上述每一种关系都有显著的统计学意义，p 值均小于 0.001。与 AIP 指数低的患者相比，AIP 指数高的患者 MACE 数量显著增加（HR：1.37，95%CI1.04-1.81；p=0.025）。RCS 曲线呈 J 形，在 0.18 处发生 HR 变化（每标准差 HR：1.20，95%CI0.96-1.50）。进一步的亚组分析支持主要发现，所有 HR 均大于 1。
AIP 指数可用于预测 PCI 后 2 年的非糖尿病性 CAD 患者。危险比与 AIP 指数之间的关系呈 J 形。尽管如此，还需要针对有潜在代谢功能障碍的非糖尿病患者进行更多的多中心研究，以确定 AIP 指数的价值。
