纤维蛋白原与高密度脂蛋白胆固醇比值作为急性心肌梗死患者死亡风险的预测因子。

Fibrinogen to HDL-Cholesterol ratio as a predictor of mortality risk in patients with acute myocardial infarction.

机构信息

Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.

Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.

出版信息

Lipids Health Dis. 2024 Mar 25;23(1):86. doi: 10.1186/s12944-024-02071-7.

DOI:10.1186/s12944-024-02071-7

PMID:38528580

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10962130/

Abstract

BACKGROUND

Acute myocardial infarction (AMI) is characterized by inflammation, oxidative stress, and atherosclerosis, contributing to increased mortality risk. High-density lipoprotein (HDL) takes a crucial part in mitigating atherosclerosis and inflammation through its diverse functionalities. Conversely, fibrinogen is implicated in the development of atherosclerotic plaques. However, the mortality risk predictive capacity of fibrinogen to HDL-cholesterol ratio (FHR) in AMI patients remains unexplored. This research aimed to evaluate the effectiveness of FHR for mortality risk prediction in relation to AMI.

METHODS

A retrospective study involving 13,221 AMI patients from the Cardiorenal ImprovemeNt II cohort (NCT05050877) was conducted. Baseline FHR levels were used to categorize patients into quartiles. The assessment of survival disparities among various groups was conducted by employing Kaplan‒Meier diagram. Cox regression was performed for investigating the correlation between FHR and adverse clinical outcomes, while the Fine-Gray model was applied to evaluate the subdistribution hazard ratios for cardiovascular death.

RESULTS

Over a median follow-up of 4.66 years, 2309 patients experienced all-cause death, with 1007 deaths attributed to cardiovascular disease (CVD). The hazard ratio (HR) and its 95% confidence interval (CI) for cardiac and all-cause death among individuals in the top quartile of FHR were 2.70 (1.99-3.65) and 1.48 (1.26-1.75), respectively, in comparison to ones in the first quartile, after covariate adjustment. Restricted cubic spline analysis revealed that FHR was linearly correlated with all-cause mortality, irrespective of whether models were adjusted or unadjusted (all P for nonlinearity > 0.05).

CONCLUSION

AMI patients with increased baseline FHR values had higher all-cause and cardiovascular mortality, regardless of established CVD risk factors. FHR holds promise as a valuable tool for evaluating mortality risk in AMI patients.

TRIAL REGISTRATION

The Cardiorenal ImprovemeNt II registry NCT05050877.

摘要

背景

急性心肌梗死（AMI）的特征是炎症、氧化应激和动脉粥样硬化，这导致了更高的死亡风险。高密度脂蛋白（HDL）通过其多种功能在减轻动脉粥样硬化和炎症方面起着至关重要的作用。相反，纤维蛋白原与动脉粥样硬化斑块的发展有关。然而，纤维蛋白原与高密度脂蛋白胆固醇比值（FHR）在 AMI 患者中的死亡风险预测能力尚未得到探索。本研究旨在评估 FHR 对 AMI 相关死亡风险预测的有效性。

方法

对来自 Cardiorenal ImprovemeNt II 队列的 13221 例 AMI 患者（NCT05050877）进行回顾性研究。使用基线 FHR 水平将患者分为四组。通过 Kaplan-Meier 图评估不同组之间的生存差异。采用 Cox 回归分析 FHR 与不良临床结局之间的相关性，采用 Fine-Gray 模型评估心血管死亡的亚分布危险比。

结果

在中位随访 4.66 年期间，2309 例患者发生全因死亡，其中 1007 例死于心血管疾病（CVD）。校正协变量后，FHR 最高四分位数的个体与最低四分位数的个体相比，心脏和全因死亡的风险比（HR）及其 95%置信区间（CI）分别为 2.70（1.99-3.65）和 1.48（1.26-1.75）。限制性三次样条分析显示，无论模型是否调整或未调整，FHR 与全因死亡率呈线性相关（所有非线性 P 值均>0.05）。