ANGPTL3 与急性冠状动脉综合征合并阻塞性睡眠呼吸暂停患者的心血管结局。
ANGPTL3 and Cardiovascular Outcomes in Patients With Acute Coronary Syndrome and Obstructive Sleep Apnea.
机构信息
Key Laboratory of Upper Airway Dysfunction-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases Beijing China.
Key Laboratory of Remodeling-Related Cardiovascular Diseases Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases Beijing China.
出版信息
J Am Heart Assoc. 2022 Sep 20;11(18):e025955. doi: 10.1161/JAHA.122.025955. Epub 2022 Sep 8.
Background The aim of this prospective study was to determine the impact of elevated ANGPTL3 (angiopoietin-like protein 3) on cardiovascular events (CVEs) following acute coronary syndrome (ACS) in patients with or without obstructive sleep apnea (OSA). Methods and Results A total of 1174 patients with ACS underwent successful percutaneous coronary intervention were included in this prospective cohort study (NCT03362385). Patients were categorized according to the apnea-hypopnea index (≥15 events/h, OSA) and further classified by ANGPTL3 levels. We analyzed the incidence of CVEs in patients with ACS according to the status of OSA and ANGPTL3. During a median of 3.1 years of follow-up, 217 (18.48%) CVEs occurred. The patients with ACS with OSA had higher ANGPTL3 levels than those without OSA (30.4 [20.9-43.2] versus 27.80 [19.1-41.5] ng/mL; <0.001). In all patients with ACS, 29≤ANGPTL3<42 mg/dL and ANGPTL3≥42 mg/dL were associated with an increased risk of CVEs with hazard ratios (HRs) of 1.555 (95% CI, 1.010-2.498) and 2.489 (95% CI 1.613-3.840), respectively. When the status of OSA or not was incorporated in stratifying factors, 29≤ANGPTL3<42 mg/dL and ANGPTL3≥42 mg/dL were associated with a significantly higher risk of CVEs in patients with ACS with OSA (HR, 1.916 [95% CI, 1.019-3.601] and HR, 2.692 [95% CI, 1.379-4.503]) but not without OSA. Moreover, adding ANGPTL3 to the Cox model increased C-statistic values by 0.035 and 0.029 in the OSA group and all patients with ACS, respectively, but was not statistically improved in patients with ACS without OSA. Conclusions In conclusion, our study demonstrates a predictive impact of plasma ANGPTL3 on cardiovascular risk in patients with ACS, especially in patients with ACS with OSA. It might be of clinical value in refining risk stratification and tailoring treatment of patients with ACS and OSA. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03362385.
背景
本前瞻性研究旨在探讨急性冠状动脉综合征（ACS）患者中，血管生成素样蛋白 3（ANGPTL3）水平升高对合并或不合并阻塞性睡眠呼吸暂停（OSA）患者心血管事件（CVE）的影响。
方法和结果
共纳入 1174 例成功行经皮冠状动脉介入治疗的 ACS 患者，进行前瞻性队列研究（NCT03362385）。根据呼吸暂停低通气指数（≥15 次/小时，OSA）将患者分为两组，并进一步根据 ANGPTL3 水平进行分组。我们分析了 ACS 患者根据 OSA 和 ANGPTL3 状态发生 CVE 的情况。中位随访 3.1 年后，发生 217 例（18.48%）CVE。与无 OSA 患者相比，合并 OSA 的 ACS 患者的 ANGPTL3 水平更高（30.4 [20.9-43.2] vs. 27.80 [19.1-41.5]ng/ml；<0.001）。在所有 ACS 患者中，29≤ANGPTL3<42 mg/dL 和 ANGPTL3≥42 mg/dL 与 CVE 风险增加相关，风险比（HR）分别为 1.555（95%CI，1.010-2.498）和 2.489（95%CI 1.613-3.840）。当纳入 OSA 状态分层因素时，29≤ANGPTL3<42 mg/dL 和 ANGPTL3≥42 mg/dL 与合并 OSA 的 ACS 患者发生 CVE 的风险显著增加相关（HR，1.916 [95%CI，1.019-3.601] 和 HR，2.692 [95%CI，1.379-4.503]），但在无 OSA 的患者中则不然。此外，在 OSA 组和所有 ACS 患者中，将 ANGPTL3 加入 Cox 模型后，C 统计量分别增加了 0.035 和 0.029，但在无 OSA 的 ACS 患者中无统计学意义。
结论
总之，本研究表明血浆 ANGPTL3 对 ACS 患者心血管风险有预测作用，尤其是对合并 OSA 的 ACS 患者。这可能对细化 ACS 和 OSA 患者的危险分层和制定治疗方案具有临床价值。
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