低密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值与经皮冠状动脉介入治疗的冠心病患者主要不良心脏和脑血管事件的关系：一项队列研究。

Association of the low-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and major adverse cardiac and cerebrovascular events in patients with coronary heart disease undergoing percutaneous coronary intervention: a cohort study.

机构信息

Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, P.R. China.

出版信息

Curr Med Res Opin. 2023 Sep;39(9):1175-1181. doi: 10.1080/03007995.2023.2246889. Epub 2023 Aug 24.

DOI:10.1080/03007995.2023.2246889

PMID:37560911

Abstract

BACKGROUND

Although dyslipidemia increases the risk of coronary heart disease (CHD) and its adverse prognosis, the association between the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and major adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with CHD has not been adequately demonstrated. Therefore, the aim of this study was to assess the role of LDL-C/HDL-C in the risk of MACCE after PCI in patients with CHD.

METHODS

In this large cohort observational study, we enrolled 2226 patients with CHD treated with PCI. LDL-C/HDL-C was considered as an exposure variable and MACCE was considered as an outcome variable. Univariate and multivariate Logistic regression models and subgroup analyses were used to assess the relationship between LDL-C/HDL-C and the risk of MACCE.

RESULTS

A total of 2226 patients (mean age: 60.02 years; 68.00% male) were included in the analysis, and 373 patients suffered MACC. Patients who developed MACCE had higher levels of LDL-C/HDL-C compared to patients who did not develop MACCE [(2.79 ± 1.15) vs (2.64 ± 1.09), = 0.023]. Univariate Logistic regression analysis showed a correlation between LDL-C/HDL-C and the risk of MACCE (OR: 1.121, 95% CI: 1.019-1.233, = 0.019). Multivariate Logistic regression analysis showed that higher levels of LDL-C/HDL-C remained strongly associated with a higher risk of MACCE after stepwise adjustment for confounding variables [Model 4: T3 vs T1, OR: 1.455, 95% CI: 1.095-1.933, = 0.010; per unit increase, OR: 1.158, 95% CI: 1.047-1.281, = 0.004]. Further subgroup analysis showed that the association between LDL-C/HDL-C and MACCE risk remained in the subgroup ≤60 years, male, without diabetes, and with hypertension ( < 0.05).

CONCLUSION

Higher LDL-C/HDL-C was closely associated with a higher risk of MACCE after PCI in patients with CHD.

摘要

背景

尽管血脂异常会增加冠心病（CHD）的风险及其不良预后，但在接受经皮冠状动脉介入治疗（PCI）的 CHD 患者中，低密度脂蛋白胆固醇（LDL-C）与高密度脂蛋白胆固醇（HDL-C）的比值与主要不良心脑血管事件（MACCE）之间的关系尚未得到充分证实。因此，本研究旨在评估 LDL-C/HDL-C 在 CHD 患者 PCI 后发生 MACCE 风险中的作用。

方法

本项大型队列观察性研究纳入了 2226 例接受 PCI 治疗的 CHD 患者。将 LDL-C/HDL-C 作为暴露变量，MACCE 作为结局变量。采用单因素和多因素 Logistic 回归模型及亚组分析来评估 LDL-C/HDL-C 与 MACCE 风险之间的关系。

结果

共纳入 2226 例患者（平均年龄：60.02 岁；68.00%为男性），其中 373 例患者发生 MACCE。与未发生 MACCE 的患者相比，发生 MACCE 的患者的 LDL-C/HDL-C 水平更高[（2.79±1.15）vs.（2.64±1.09）， = 0.023]。单因素 Logistic 回归分析显示，LDL-C/HDL-C 与 MACCE 风险之间存在相关性（OR：1.121，95%CI：1.019-1.233， = 0.019）。多因素 Logistic 回归分析显示，在校正混杂因素后，较高的 LDL-C/HDL-C 水平与 MACCE 风险升高仍密切相关[模型 4：T3 与 T1 相比，OR：1.455，95%CI：1.095-1.933， = 0.010；每单位增加，OR：1.158，95%CI：1.047-1.281， = 0.004]。进一步的亚组分析显示，在年龄≤60 岁、男性、无糖尿病和高血压的患者亚组中，LDL-C/HDL-C 与 MACCE 风险之间的关联仍然存在（ < 0.05）。