残余胆固醇升高可重新分类缺血性心脏病和心肌梗死的风险。

Elevated Remnant Cholesterol Reclassifies Risk of Ischemic Heart Disease and Myocardial Infarction.

机构信息

Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.

出版信息

J Am Coll Cardiol. 2022 Jun 21;79(24):2383-2397. doi: 10.1016/j.jacc.2022.03.384.

DOI:10.1016/j.jacc.2022.03.384

PMID:35710189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8972554/

Abstract

BACKGROUND

Elevated remnant cholesterol causes ischemic heart disease.

OBJECTIVES

We tested the hypothesis that the inclusion of elevated remnant cholesterol will lead to appropriate reclassification of individuals who later experience myocardial infarction and ischemic heart disease.

METHODS

For >10 years we followed up 41,928 white Danish individuals from the Copenhagen General Population Study without a history of ischemic cardiovascular disease, diabetes, and statin use. Using predefined cut points for elevated remnant cholesterol, we calculated net reclassification index (NRI) from below to above 5%, 7.5%, and/or 10% 10-year occurrence of myocardial infarction and ischemic heart disease defined as a composite of death from ischemic heart disease, myocardial infarction, and coronary revascularization.

RESULTS

For individuals with remnant cholesterol levels ≥95th percentile (≥1.6 mmol/L, 61 mg/dL), 23% (P < 0.001) of myocardial infarction and 21% (P < 0.001) of ischemic heart disease were reclassified correctly from below to above 5% for 10-year occurrence when remnant cholesterol levels were added to models based on conventional risk factors, whereas no events were reclassified incorrectly. Consequently, the addition of remnant cholesterol levels yielded NRI of 10% (95% CI: 1%-20%) for myocardial infarction and 5% (95% CI: -3% to 13%) for ischemic heart disease. Correspondingly, when reclassifications were combined from below to above 5%, 7.5%, and 10% risk of events, 42% (P < 0.001) of individuals with myocardial infarction and 41% (P < 0.001) with ischemic heart disease were reclassified appropriately, leading to NRI of respectively 20% (95% CI: 9%-31%) and 11% (95% CI: 2%-21%).

CONCLUSIONS

Elevated remnant cholesterol levels considerably improve myocardial infarction and ischemic heart disease risk prediction.

摘要

背景

升高的残余胆固醇会导致缺血性心脏病。

目的

我们检验了这样一个假设，即纳入升高的残余胆固醇将导致后来经历心肌梗死和缺血性心脏病的个体得到适当的重新分类。

方法

在超过 10 年的时间里，我们对来自哥本哈根普通人群研究的 41928 名没有缺血性心血管疾病、糖尿病和他汀类药物使用史的白人丹麦个体进行了随访。使用升高的残余胆固醇的预设切点，我们计算了从低于到高于 5%、7.5%和/或 10%的净重新分类指数（NRI），定义为缺血性心脏病死亡、心肌梗死和冠状动脉血运重建的复合终点。

结果

对于残余胆固醇水平≥第 95 百分位数（≥1.6mmol/L，61mg/dL）的个体，当将残余胆固醇水平添加到基于常规危险因素的模型中时，23%（P<0.001）的心肌梗死和 21%（P<0.001）的缺血性心脏病事件被正确地从低于到高于 5%进行了重新分类，而没有事件被错误地重新分类。因此，残余胆固醇水平的增加导致心肌梗死的 NRI 为 10%（95%CI：1%-20%），缺血性心脏病的 NRI 为 5%（95%CI：-3%至 13%）。相应地，当从低于到高于 5%、7.5%和 10%的风险事件进行重新分类时，42%（P<0.001）的心肌梗死和 41%（P<0.001）的缺血性心脏病患者得到了适当的重新分类，导致 NRI 分别为 20%（95%CI：9%-31%）和 11%（95%CI：2%-21%）。