Yildiz Mehmet, Miedema Michael D, Murthy Avinash, Henry Timothy D, Bergstedt Seth, Okeson Brynn K, Schmidt Christian W, Volpenhein Lucas, Garcia Santiago, Sharkey Scott W, Aguirre Frank V
The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH, USA.
Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Heliyon. 2023 Jun 14;9(6):e17308. doi: 10.1016/j.heliyon.2023.e17308. eCollection 2023 Jun.
Although there is an established association between elevated triglyceride (eTG, ≥175 mg/dl) levels and adverse cardiovascular events, some studies have suggested that eTG levels may be linked to neutral or even improved clinical outcomes, particularly among patients with acute myocardial infarction. However, these studies had certain limitations, including small sample sizes, heterogeneous study populations, and inadequate statistical adjustments. To address these limitations, we conducted an analysis of 5347 patients with ST-segment elevation myocardial infarction (STEMI) between March 2003 and December 2020, using a prospective registry-based cohort from two large, regional STEMI centers. We used a triglyceride level of 175 mg/dl as the cutoff point for eTG levels. Of the study participants, 24.5% (n = 1312) had eTG levels. These patients were more likely to be younger, male, and have a higher number of cardiovascular risk factors compared to those with low TG levels. Despite these unfavorable cardiovascular risk profiles, patients with eTG levels had lower unadjusted risks of 1-year major adverse cardiac events (MACE) -a composite of myocardial infarction, stroke, and death- than those with low TG levels (8.8% vs. 11%, p = 0.034). However, after adjusting for certain clinical factors and lipid profile, eTG levels were not associated with a lower 1-year MACE (aHR: 1.10 (0.71-1.70), p = 0.7). In conclusion, a quarter of STEMI patients had eTG levels and these patients had comparable long-term cardiovascular outcomes compared to those with low TG levels after controlling for clinical factors and lipid profile.
尽管甘油三酯水平升高（eTG，≥175mg/dl）与不良心血管事件之间存在既定关联，但一些研究表明，eTG水平可能与中性甚至改善的临床结局相关，尤其是在急性心肌梗死患者中。然而，这些研究存在一定局限性，包括样本量小、研究人群异质性以及统计调整不足。为解决这些局限性，我们对2003年3月至2020年12月期间的5347例ST段抬高型心肌梗死（STEMI）患者进行了分析，使用了来自两个大型区域STEMI中心的基于前瞻性登记的队列。我们将甘油三酯水平175mg/dl作为eTG水平的切点。在研究参与者中，24.5%（n = 1312）有eTG水平。与甘油三酯水平低的患者相比，这些患者更可能年轻、为男性且有更多心血管危险因素。尽管存在这些不利的心血管风险特征，但eTG水平的患者1年主要不良心脏事件（MACE，心肌梗死、中风和死亡的综合）的未调整风险低于甘油三酯水平低的患者（8.8%对11%，p = 0.034）。然而，在调整某些临床因素和血脂谱后，eTG水平与较低的1年MACE无关（aHR：1.10（0.71 - 1.70），p = 0.7）。总之，四分之一的STEMI患者有eTG水平，在控制临床因素和血脂谱后，这些患者与甘油三酯水平低的患者相比有相当的长期心血管结局。
