Lee Heesun, Ahn Hyo-Jeong, Park Hyo Eun, Han Donghee, Chang Hyuk-Jae, Chun Eun Ju, Han Hae-Won, Sung Jidong, Jung Hae Ok, Choi Su-Yeon
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea.
Front Cardiovasc Med. 2023 Jul 17;10:1173289. doi: 10.3389/fcvm.2023.1173289. eCollection 2023.
Despite the importance of attaining optimal lipid levels from a young age to secure long-term cardiovascular health, the detailed impact of non-optimal lipid levels in young adults on coronary artery calcification (CAC) is not fully explored. We sought to investigate the risk of CAC progression as per lipid profiles and to demonstrate lipid optimality in young adults.
From the KOrea Initiative on Coronary Artery calcification (KOICA) registry that was established in six large volume healthcare centers in Korea, 2,940 statin-naïve participants aged 20-45 years who underwent serial coronary calcium scans for routine health check-ups between 2002 and 2017 were included. The study outcome was CAC progression, which was assessed by the square root method. The risk of CAC progression was analyzed according to the lipid optimality and each lipid parameter.
In this retrospective cohort (mean age, 41.3 years; men 82.4%), 477 participants (16.2%) had an optimal lipid profile, defined as triglycerides <150 mg/dl, LDL cholesterol <100 mg/dl, and HDL cholesterol >60 mg/dl. During follow-up (median, 39.7 months), CAC progression was observed in 434 participants (14.8%), and more frequent in the non-optimal lipid group (16.5% vs. 5.7%; < 0.001). Non-optimal lipids independently increased the risk of CAC progression [adjusted hazard ratio (aHR), 1.97; = 0.025], in a dose-dependent manner. Even in relatively low-risk participants with an initial calcium score of zero (aHR, 2.13; = 0.014), in their 20 s or 30 s (aHR 2.15; = 0.041), and without other risk factors (aHR 1.45; = 0.038), similar results were demonstrable. High triglycerides had the greatest impact on CAC progression in this young adult population.
Non-optimal lipid levels were significantly associated with the risk of CAC progression in young adults, even at low-risk. Screening and intervention for non-optimal lipid levels, particularly triglycerides, from an early age might be of clinical value.
尽管从年轻时就达到最佳血脂水平对于确保长期心血管健康至关重要，但年轻成年人血脂水平不理想对冠状动脉钙化（CAC）的具体影响尚未得到充分研究。我们试图根据血脂谱调查CAC进展的风险，并证明年轻成年人的血脂最佳状态。
从韩国在六个大型医疗中心建立的冠状动脉钙化韩国倡议（KOICA）登记处，纳入了2940名年龄在20-45岁之间、在2002年至2017年期间接受系列冠状动脉钙扫描进行常规健康检查的未服用他汀类药物的参与者。研究结果是CAC进展，通过平方根法进行评估。根据血脂最佳状态和每个血脂参数分析CAC进展的风险。
在这个回顾性队列中（平均年龄41.3岁；男性占82.4%），477名参与者（16.2%）具有最佳血脂谱，定义为甘油三酯<150mg/dl、低密度脂蛋白胆固醇<100mg/dl和高密度脂蛋白胆固醇>60mg/dl。在随访期间（中位数为39.7个月），434名参与者（14.8%）出现了CAC进展，在血脂不理想组中更常见（16.5%对5.7%；P<0.001）。不理想的血脂独立增加了CAC进展的风险[调整后的危险比（aHR），1.97；P=0.025]，呈剂量依赖性。即使在初始钙评分为零的相对低风险参与者中（aHR，2.13；P=0.014）、20多岁或30多岁的参与者中（aHR 2.15；P=0.041）以及没有其他风险因素的参与者中（aHR 1.45；P=0.038），也得到了类似的结果。在这个年轻成年人群体中，高甘油三酯对CAC进展的影响最大。
即使在低风险情况下，不理想的血脂水平也与年轻成年人CAC进展的风险显著相关。从年轻时就对不理想的血脂水平，特别是甘油三酯进行筛查和干预可能具有临床价值。
