代谢控制对早发冠心病患者复发性主要不良心血管事件和心血管死亡率的影响：动脉粥样硬化性疾病遗传学研究结果。

Effect of metabolic control on recurrent major adverse cardiovascular events and cardiovascular mortality in patients with premature coronary artery disease: Results of the Genetics of Atherosclerotic Disease study.

机构信息

Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

出版信息

Nutr Metab Cardiovasc Dis. 2022 Sep;32(9):2227-2237. doi: 10.1016/j.numecd.2022.06.008. Epub 2022 Jun 15.

DOI:10.1016/j.numecd.2022.06.008

PMID:35843799

Abstract

BACKGROUND AND AIMS

Coronary artery disease (CAD) is the leading cause of death around the world, and its rate of presentation is increasing at young ages. Despite the evidence that secondary prevention in CAD reduces the risk of recurrent major adverse cardiovascular events (MACE), no studies have analyzed the composite control of blood pressure, lipids, and glucose control in premature CAD.

METHODS AND RESULTS

This was a real-world prospective cohort study of patients with premature CAD. The composite control in blood pressure <140/80 mmHg, LDL-C <70 mg/dL, non-HDL-C <100 mg/dL, and Hemoglobin A1c <8% was considered as metabolic control. The primary endpoint was the occurrence of non-fatal and fatal MACE. The data included 1042 patients with premature CAD. The mean age of the patients was 54.1 ± 8.1 years, 18.5% were women, and had a median follow-up of 59.1 ± 11.8 months. Of them, 7% had non-fatal MACE, and 4% had a fatal MACE. Overall, 21.3% achieved metabolic control, and 3.0% did not achieve any target. Cox regression analysis showed that percutaneous coronary intervention (Hazzard ratio = 1.883 [95% CI, 1.131-3.136]), C-reactive protein (1.046 [1.020-1.073]), blood pressure >140/90 mmHg (2.686 [1.506-4.791]), fibrates (2.032 [1.160-3.562]), calcium channel blockers (2.082 [1.158-3.744]) had greater risk to present a recurrent non-fatal MACE; whereas familial history of premature CAD (2.419 [1.240-4.721]), heart failure (2.139 [1.032-4.433]), LDL-C >70 mg/dL (4.594 [1.401-15.069]), and diuretics (3.328 [1.677-6.605]) were associated with cardiovascular mortality.

CONCLUSIONS

The composite goal achievement in lipids, blood pressure and glucose, reduced the risk for recurrent MACE in 80%.

摘要

背景与目的

冠心病（CAD）是全球范围内主要的死亡原因，且其发病年龄呈年轻化趋势。尽管已有证据表明 CAD 的二级预防可降低复发性主要不良心血管事件（MACE）的风险，但尚无研究分析过在早发 CAD 中血压、血脂和血糖控制的综合管理。

方法和结果

这是一项针对早发 CAD 患者的真实世界前瞻性队列研究。血压<140/80mmHg、LDL-C<70mg/dL、非-HDL-C<100mg/dL 和糖化血红蛋白<8%的综合控制被认为是代谢控制。主要终点是发生非致死性和致死性 MACE。数据包括 1042 例早发 CAD 患者。患者的平均年龄为 54.1±8.1 岁，18.5%为女性，中位随访时间为 59.1±11.8 个月。其中，7%发生非致死性 MACE，4%发生致死性 MACE。总体而言，21.3%的患者达到了代谢控制目标，3.0%的患者未达到任何目标。Cox 回归分析显示，经皮冠状动脉介入治疗（危险比=1.883[95%可信区间，1.131-3.136]）、C 反应蛋白（1.046[1.020-1.073]）、血压>140/90mmHg（2.686[1.506-4.791]）、贝特类药物（2.032[1.160-3.562]）、钙通道阻滞剂（2.082[1.158-3.744]）与复发性非致死性 MACE 的发生风险更高；而早发 CAD 的家族史（2.419[1.240-4.721]）、心力衰竭（2.139[1.032-4.433]）、LDL-C>70mg/dL（4.594[1.401-15.069]）和利尿剂（3.328[1.677-6.605]）与心血管死亡率相关。