残胆固醇与冠状动脉钙进展风险：来自 CARDIA 和 MESA 研究的新见解。
Remnant Cholesterol and the Risk of Coronary Artery Calcium Progression: Insights From the CARDIA and MESA Study.
机构信息
Department of Cardiology (Q.-Y.H., J.-W.G., J.-F.W., P.-M.L.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Clinical Nutrition (Z.-M.Y.), Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
Circ Cardiovasc Imaging. 2022 Jul;15(7):e014116. doi: 10.1161/CIRCIMAGING.122.014116. Epub 2022 Jul 8.
BACKGROUND
Remnant cholesterol (RC) contributes to residual risk of atherosclerotic cardiovascular disease, but population-based evidence on the prospective relationship between RC and coronary artery calcium (CAC) progression is rare.
METHODS
We pooled data obtained from 6544 atherosclerotic cardiovascular disease-free individuals from the CARDIA study (Coronary Artery Risk Development in Young Adults; n=2635) and MESA (Multi-Ethnic Study of Atherosclerosis; n=3909), with a mean±SD age of 47.2±19.8 years; 3019 (46.1%) were men who completed computed tomography of CAC at baseline. RC was measured as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus calculated LDL (low-density lipoprotein) cholesterol (LDL-C) estimated by using the Martin/Hopkins equation. Adjusted Cox models were used to assess the relationships between RC levels and CAC progression. We also performed discordance analyses examining the risk of CAC progression in RC versus LDL-C discordant/concordant groups using median cut points and clinically relevant LDL-C targets.
RESULTS
During a median follow-up of 8.6 years, 2778 (42.5%) participants had CAC progression. After multivariable adjustment for demographics and cardiovascular risk factors, a 1-mg/dL increase in RC levels was associated with a 1.3% higher risk of CAC progression (hazard ratio, 1.013 [95% CI, 1.008-1.017]). Results were similar when we categorized individuals by RC quartiles. Furthermore, the discordant high RC/low LDL-C group had a significantly higher risk of CAC progression than the concordant low RC/LDL-C group regarding their medians (hazard ratio, 1.195 [95% CI, 1.063-1.343]) or when setting the clinical LDL-C cut points at 100 and 130 but not 70 mg/dL. The association remained robust across a series of sensitivity analyses.
CONCLUSIONS
Elevated RC levels were associated with an increased risk of CAC progression independent of traditional cardiovascular risk factors, even in individuals with optimal LDL-C levels.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifiers: NCT00005130 (CARDIA) and NCT00005487 (MESA).
背景
残余胆固醇（RC）是动脉粥样硬化性心血管疾病残余风险的一个因素，但人群中 RC 与冠状动脉钙（CAC）进展之间的前瞻性关系的证据很少。
方法
我们汇总了来自 CARDIA 研究（年轻人冠状动脉风险发展研究；n=2635）和 MESA（动脉粥样硬化多民族研究；n=3909）的 6544 例无动脉粥样硬化性心血管疾病个体的数据，平均年龄为 47.2±19.8 岁；其中 3019 名（46.1%）男性在基线时完成了 CAC 的计算机断层扫描。RC 通过使用 Martin/Hopkins 方程计算总胆固醇减去高密度脂蛋白（HDL）胆固醇减去计算出的 LDL（低密度脂蛋白）胆固醇（LDL-C）来测量。使用调整后的 Cox 模型评估 RC 水平与 CAC 进展之间的关系。我们还进行了不和谐分析，使用中位数切点和临床相关的 LDL-C 目标检查 RC 与 LDL-C 不和谐/一致组中 CAC 进展的风险。
结果
在中位随访 8.6 年期间，2778 名（42.5%）参与者发生 CAC 进展。经过多变量调整人口统计学和心血管危险因素后，RC 水平每增加 1mg/dL，CAC 进展的风险增加 1.3%（风险比，1.013[95%CI，1.008-1.017]）。当按 RC 四分位数对个体进行分类时，结果相似。此外，在中位数（危险比，1.195[95%CI，1.063-1.343]）或设定临床 LDL-C 切点为 100 和 130 但不是 70mg/dL 时，RC 较高/LDL-C 较低的不和谐组比 RC/LDL-C 均较低的一致组的 CAC 进展风险显著更高。该关联在一系列敏感性分析中仍然稳健。
结论
升高的 RC 水平与 CAC 进展风险增加相关，独立于传统心血管危险因素，即使在 LDL-C 水平最佳的个体中也是如此。
注册
网址：https://www.
临床试验
gov；独特标识符：NCT00005130（CARDIA）和 NCT00005487（MESA）。
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