残余胆固醇与高密度脂蛋白胆固醇比值与冠心病风险的关系。

Association between the remnant cholesterol to high-density lipoprotein cholesterol ratio and the risk of coronary artery disease.

机构信息

Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine.

Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Coron Artery Dis. 2024 Mar 1;35(2):114-121. doi: 10.1097/MCA.0000000000001320. Epub 2024 Jan 6.

DOI:10.1097/MCA.0000000000001320

PMID:38189652

Abstract

BACKGROUND

The purpose of this study was to evaluate the relationship between remnant cholesterol (RC) to high-density lipoprotein cholesterol (HDL-C) ratio and the risk of coronary artery disease (CAD). We also investigated the clinical value of RC/HDL-C ratio in evaluating the severity of CAD and in predicting the short-term prognosis of CAD patients.

METHODS

In total, 615 patients were enrolled and they were classified into a CAD group (418 cases) and a normal group (197 cases) according to the results of coronary angiography. Serum RC/HDL-C ratio and Gensini score were calculated. Multivariate logistic regression and receiver operating characteristic (ROC) curves were employed to evaluate the association between RC/HDL-C ratio and CAD. The effect of RC/HDL-C ratio on the progression of major adverse cardiovascular events (MACEs) was also explored.

RESULTS

Increased RC/HDL-C ratio was associated with an increased risk of CAD (OR: 11.122; 95% CI: 5.903-20.954; P < 0.001). When stratified by CAD subtypes, increased RC/HDL-C ratio was correlated with a greater risk of acute coronary syndrome (ACS) (OR:1.549; 95% CI: 1.014-2.364; P < 0.05). Compared with the first quartile, the 4th quartile of RC/HDL-C ratio had a 9.774-fold ( P = 0.000) increase in the odds ratio for CAD, and a 2.241-fold ( P = 0.017) increase in the odds ratio for ACS. RC/HDL-C ratio was an independent determinant of Gensini score ≥32 (OR: 2.138, 95% CI:1.389-3.292, P < 0.01), and multi-branch (MVD) (OR: 2.245; 95% CI: 1.468-3.443; P < 0.001). The prevalence of Gensini score ≥32 and MVD in the 4th quartile of RC/HDL-C ratio group were much higher than that of other quartile groups ( P < 0.01). Moreover, the areas under the ROC for the predictive value of RC/HDL-C ratio for CAD, ACS, Gensini score ≥32, and MVD were 0.702, 0.563, 0.602, and 0.669, respectively. Furthermore, the incidence of MACEs was significantly increased in CAD patients with levels of RC/HDL-C ratio ( P < 0.05).

CONCLUSION

RC/HDL-C ratio plays an important role in the progression and severity of CAD.

摘要

背景

本研究旨在评估残余胆固醇（RC）与高密度脂蛋白胆固醇（HDL-C）比值与冠心病（CAD）风险之间的关系。我们还研究了 RC/HDL-C 比值在评估 CAD 严重程度和预测 CAD 患者短期预后方面的临床价值。

方法

共纳入 615 例患者，根据冠状动脉造影结果分为 CAD 组（418 例）和正常组（197 例）。计算血清 RC/HDL-C 比值和 Gensini 评分。采用多变量逻辑回归和受试者工作特征（ROC）曲线评估 RC/HDL-C 比值与 CAD 的关系。还探讨了 RC/HDL-C 比值对主要不良心血管事件（MACE）进展的影响。

结果

RC/HDL-C 比值升高与 CAD 风险增加相关（OR：11.122；95%CI：5.903-20.954；P<0.001）。按 CAD 亚型分层，RC/HDL-C 比值升高与急性冠脉综合征（ACS）风险增加相关（OR：1.549；95%CI：1.014-2.364；P<0.05）。与第 1 四分位相比，RC/HDL-C 比值第 4 四分位 CAD 的比值比（OR）增加了 9.774 倍（P=0.000），ACS 的比值比增加了 2.241 倍（P=0.017）。RC/HDL-C 比值是 Gensini 评分≥32（OR：2.138，95%CI：1.389-3.292，P<0.01）和多支病变（MVD）（OR：2.245；95%CI：1.468-3.443；P<0.001）的独立决定因素。RC/HDL-C 比值第 4 四分位组 Gensini 评分≥32 和 MVD 的患病率明显高于其他四分位组（P<0.01）。此外，RC/HDL-C 比值对 CAD、ACS、Gensini 评分≥32 和 MVD 的预测价值的 ROC 曲线下面积分别为 0.702、0.563、0.602 和 0.669。此外，CAD 患者的 RC/HDL-C 比值水平显著增加了 MACE 的发生率（P<0.05）。