Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China.
Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China.
Eur J Prev Cardiol. 2023 Nov 30;30(17):1924-1934. doi: 10.1093/eurjpc/zwad297.
Remnant cholesterol (RC) reportedly mediates residual cardiovascular risk in atherosclerotic cardiovascular diseases (ASCVD). However, few studies have characterized long-term cumulative RC exposure among elderly people. The study aimed to evaluate the association between cumulative exposure to RC and incident major adverse cardiovascular events (MACE) by analysing a cohort of elderly patients with ASCVD.
This retrospective multicentre cohort study enrolled ASCVD participants aged ≥75 years with baseline visits occurring from 2006 to 2012 followed by four in-person visits. Cumulative RC was estimated as the area under the curve using measurements from the first to fourth visits by using 9-year data. The time-weighted average (TWA) RC was expressed as cumulative exposure to RC averaged by years. All outcomes were follow-up from the fourth visit to the year 2021. Outcomes included a composite of MACE (stroke, unstable angina pectoris, myocardial infarction, and cardiac death). We included 4,680 participants (73.1% male, mean age 79.3 ± 2.5 years). The median follow-up duration was 6.1 years (interquartile range: 3.4-6.6 years). In the multivariable model adjusted for traditional cardiovascular risk factors, low-density lipoprotein cholesterol level, and most recent RC level, the hazard ratios for MACE that compared the high and low tertiles of the RC variables were 1.30 [95% confidence interval (CI), 1.16-1.44] for cumulative RC and 1.36 (95% CI, 1.23-1.52) for TWA RC. Consistent significant associations were observed among most propensity score analyses.
Long-term cumulative RC was independently associated with incident MACE in elderly participants with ASCVD, suggesting that achieving and maintaining optimal RC levels later in life may still improve cardiovascular outcomes.
据报道，残余胆固醇（RC）介导了动脉粥样硬化性心血管疾病（ASCVD）中的残余心血管风险。然而，很少有研究描述老年人长期累积 RC 暴露情况。本研究旨在通过分析 ASCVD 老年患者队列，评估累积 RC 暴露与主要不良心血管事件（MACE）事件的相关性。
这是一项回顾性多中心队列研究，纳入了年龄≥75 岁的 ASCVD 患者，基线访视时间为 2006 年至 2012 年，随后进行了 4 次面对面访视。使用第 1 至第 4 次访视的测量值，通过 9 年的数据计算累积 RC，作为曲线下面积。时间加权平均（TWA）RC 表示按年平均的 RC 累积暴露。所有结局均从第 4 次访视随访至 2021 年。结局包括 MACE（中风、不稳定型心绞痛、心肌梗死和心源性死亡）的复合事件。共纳入 4680 名参与者（73.1%为男性，平均年龄 79.3±2.5 岁）。中位随访时间为 6.1 年（四分位距：3.4-6.6 年）。在调整传统心血管危险因素、低密度脂蛋白胆固醇水平和最近 RC 水平的多变量模型中，与 RC 变量的高、低三分位数相比，MACE 的危险比分别为 1.30（95%可信区间，1.16-1.44）和 1.36（95%可信区间，1.23-1.52）。在大多数倾向评分分析中均观察到一致的显著相关性。
长期累积 RC 与 ASCVD 老年患者的 MACE 事件独立相关，表明在生命后期实现并维持最佳 RC 水平可能仍能改善心血管结局。
