人群中残余胆固醇变异性与缺血性卒中的发生。
Remnant Cholesterol Variability and Incident Ischemic Stroke in the General Population.
机构信息
Shantou University Medical College, China (W.L., Z.H., W.F., X.W.).
Department of Cardiology, Second Affiliated Hospital of Shantou University Medical College, China (Z. Cai, W.W., Z. Chen, Y.C.).
出版信息
Stroke. 2022 Jun;53(6):1934-1941. doi: 10.1161/STROKEAHA.121.037756. Epub 2022 May 11.
BACKGROUND
Studies have demonstrated that remnant cholesterol is correlated with the risk of ischemic stroke. However, it is unknown whether visit-to-visit variability in remnant cholesterol concentration affects ischemic stroke. We sought to examine the role of remnant cholesterol variability in the subsequent development of ischemic stroke in the general population.
METHODS
We performed a post hoc analysis including eligible participants from the Kailuan Study cohort who underwent 3 health examinations and were free of atrial fibrillation, myocardial infarction, stroke, cancer, or known lipid-medication use from 2006 to 2010. Participants were followed up until the end of 2017. Variability was quantified as variability independent of the mean, average real variability, and SD. Multivariate analysis was performed using the Fine and Gray competing risk model to estimate subhazard ratios assuming death as a competing risk.
RESULTS
The final study cohort comprised 38 556 participants. After a median follow-up of 7.0 years, 1058 individuals were newly diagnosed with ischemic stroke. After adjusting for age (time scale), sex, smoking status, alcohol consumption, physical activity, hypertension, diabetes, family history of cardiovascular disease, body mass index, estimated glomerular filtration rate, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and mean remnant cholesterol, the highest quartile (quartile 4) of variability independent of the mean of remnant cholesterol was associated with an increased ischemic stroke risk compared with the lowest quartile (quartile 1), (subhazard ratio, 1.27 [95% CI, 1.06-1.53]). For each 1-SD increase in variability independent of the mean of remnant cholesterol, the risk increased by 9% (subhazard ratio, 1.09 [95% CI, 1.03-1.16]). The association was also significant using average real variability and SD as indices of variability.
CONCLUSIONS
Greater remnant cholesterol variability was associated with a higher risk of ischemic stroke in the general population.
背景
研究表明，残余胆固醇与缺血性卒中风险相关。然而，残余胆固醇浓度的变异性是否会影响缺血性卒中尚不清楚。我们旨在探讨一般人群中残余胆固醇变异性在随后发生缺血性卒中中的作用。
方法
我们对参加开滦研究队列的合格参与者进行了一项事后分析，这些参与者在 2006 年至 2010 年期间接受了 3 次健康检查，且无心房颤动、心肌梗死、卒中、癌症或已知的血脂药物使用史。参与者随访至 2017 年底。变异性通过均值独立变异、平均真实变异和标准差进行量化。使用 Fine 和 Gray 竞争风险模型进行多变量分析，假设死亡为竞争风险，以估计亚危险比。
结果
最终研究队列包括 38556 名参与者。在中位随访 7.0 年后，1058 人被新诊断为缺血性卒中。在校正年龄（时间尺度）、性别、吸烟状态、饮酒状况、体力活动、高血压、糖尿病、心血管疾病家族史、体重指数、估算肾小球滤过率、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、甘油三酯和平均残余胆固醇后，残余胆固醇均值独立变异的最高四分位数（四分位 4）与最低四分位数（四分位 1）相比，缺血性卒中风险增加（亚危险比，1.27 [95%CI，1.06-1.53]）。残余胆固醇均值独立变异每增加 1-SD，风险增加 9%（亚危险比，1.09 [95%CI，1.03-1.16]）。使用平均真实变异和标准差作为变异指标，也观察到了同样的关联。
结论
残余胆固醇变异性越大，一般人群发生缺血性卒中的风险越高。
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