Zhao Lang, Zhao Xuemei, Tian Pengchao, Liang Lin, Huang Boping, Huang Liyan, Feng Jiayu, Zhang Yuhui, Zhang Jian
Department of Emergency, China-Japan Friendship Hospital, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2023 Feb 15;10:1063562. doi: 10.3389/fcvm.2023.1063562. eCollection 2023.
Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown.
To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients.
This study enrolled 2,823 patients hospitalized for HF. Kaplan-Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF.
The mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46-0.68, < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47-0.73, < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003-0.017; NRI = 0.036, 95% CI: 0.003-0.070; IDI = 0.025, 95% CI: 0.018-0.033; all < 0.05).
Low remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors.
ClinicalTrials.gov, Unique Identifier: NCT02664818.
较低的胆固醇水平与心力衰竭（HF）患者死亡率增加相关。残余胆固醇是指在高密度脂蛋白（HDL）和低密度脂蛋白（LDL）中未发现的所有胆固醇。残余胆固醇在HF中的预后作用尚不清楚。
揭示HF患者基线残余胆固醇水平与全因死亡率之间的关系。
本研究纳入了2823例因HF住院的患者。采用Kaplan-Meier分析、Cox回归、C统计量、净重新分类改善（NRI）和综合判别改善（IDI）来评估残余胆固醇对HF患者全因死亡率的预后价值。
残余胆固醇第四四分位数组的死亡率最低，相对于第一四分位数组，其死亡调整风险比（HR）为0.56[HR：0.39，95%置信区间（CI）：0.46-0.68，<0.001]。调整后，残余胆固醇水平每增加一个单位，全因死亡风险降低41%（HR：0.59，95%CI：0.47-0.73，<0.001）。在原模型中加入残余胆固醇四分位数后，风险预测得到改善（ΔC统计量=0.010，95%CI：0.003-0.017；NRI=0.036，95%CI：0.003-0.070；IDI=0.025，95%CI：0.018-0.033；均<0.05）。
低残余胆固醇水平与HF患者全因死亡率增加相关。加入残余胆固醇四分位数提高了相对于传统危险因素的预测价值。
ClinicalTrials.gov，唯一标识符：NCT02664818。
