Department of Clinical Biochemistry and the Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Arterioscler Thromb Vasc Biol. 2024 May;44(5):1144-1155. doi: 10.1161/ATVBAHA.123.320175. Epub 2024 Mar 21.
Elevated apoB-containing lipoproteins (=remnants+LDLs [low-density lipoproteins]) are a major risk factor for atherosclerotic cardiovascular disease, including peripheral artery disease (PAD) and myocardial infarction. We tested the hypothesis that remnants and LDL both explain part of the increased risk of PAD conferred by elevated apoB-containing lipoproteins. For comparison, we also studied the risk of chronic limb-threatening ischemia and myocardial infarction.
apoB, remnant cholesterol, and LDL cholesterol were measured in 93 461 individuals without statin use at baseline from the Copenhagen General Population Study (2003-2015). During up to 15 years of follow-up, 1207 had PAD, 552 had chronic limb-threatening ischemia, and 2022 had myocardial infarction in the Danish National Patient Registry. Remnant and LDL cholesterol were calculated from a standard lipid profile. Remnant and LDL particle counts were additionally measured with nuclear magnetic resonance spectroscopy in 25 347 of the individuals. Results were replicated in 302 167 individuals without statin use from the UK Biobank (2004-2010).
In the Copenhagen General Population Study, multivariable adjusted hazard ratios for risk of PAD per 1 mmol/L (39 mg/dL) increment in remnant and LDL cholesterol were 1.9 (95% CI, 1.5-2.4) and 1.1 (95% CI, 1.0-1.2), respectively; corresponding results in the UK Biobank were 1.7 (95% CI, 1.4-2.1) and 0.9 (95% CI, 0.9-1.0), respectively. In the association from elevated apoB to increased risk of PAD, remnant and LDL cholesterol explained 73% (32%-100%) and 8% (0%-46%), respectively; corresponding results were 63% (30%-100%) and 0% (0%-33%) for risk of chronic limb-threatening ischemia and 41% (27%-55%) and 54% (38%-70%) for risk of myocardial infarction; results for remnant and LDL particle counts corroborated these findings.
PAD risk conferred by elevated apoB-containing lipoproteins was explained mainly by elevated remnants, while myocardial infarction risk was explained by both elevated remnants and LDL.
载有 ApoB 的脂蛋白（=残粒+LDL [低密度脂蛋白]）升高是动脉粥样硬化性心血管疾病（包括外周动脉疾病[PAD]和心肌梗死）的主要危险因素。我们检验了以下假设，即残粒和 LDL 均可以解释载有 ApoB 的脂蛋白升高导致 PAD 风险增加的部分原因。为了进行比较，我们还研究了慢性肢体威胁性缺血和心肌梗死的风险。
在哥本哈根普通人群研究（2003-2015 年）中，在基线时未使用他汀类药物的 93461 名个体中测量了 apoB、残粒胆固醇和 LDL 胆固醇。在长达 15 年的随访期间，丹麦国家患者登记处中有 1207 人患有 PAD，552 人患有慢性肢体威胁性缺血，2022 人患有心肌梗死。残粒和 LDL 胆固醇是根据标准血脂谱计算得出的。在 25347 名个体中，还通过核磁共振光谱法测量了残粒和 LDL 颗粒计数。在没有使用他汀类药物的 302167 名英国生物库个体（2004-2010 年）中复制了结果。
在哥本哈根普通人群研究中，每增加 1mmol/L（39mg/dL）残粒和 LDL 胆固醇，风险比（HR）分别为 1.9（95%CI，1.5-2.4）和 1.1（95%CI，1.0-1.2）；在英国生物库中的相应结果分别为 1.7（95%CI，1.4-2.1）和 0.9（95%CI，0.9-1.0）。在载有 ApoB 升高与 PAD 风险增加的关联中，残粒和 LDL 胆固醇分别解释了 73%（32%-100%）和 8%（0%-46%）；相应的结果是，慢性肢体威胁性缺血的风险为 63%（30%-100%）和 0%（0%-33%），心肌梗死的风险为 41%（27%-55%）和 54%（38%-70%）；残粒和 LDL 颗粒计数的结果证实了这些发现。
载有 ApoB 的脂蛋白升高导致 PAD 的风险主要由残粒升高引起，而心肌梗死的风险则由残粒和 LDL 共同引起。
