高密度脂蛋白胆固醇与冠状动脉旁路移植术后不良结局的性别相关性。

Sex-based association between high-density lipoprotein cholesterol and adverse outcomes after coronary artery bypass grafting.

机构信息

Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

BMC Cardiovasc Disord. 2024 Apr 5;24(1):194. doi: 10.1186/s12872-024-03806-1.

DOI:10.1186/s12872-024-03806-1

PMID:38580951

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10996185/

Abstract

BACKGROUND

High-density lipoprotein cholesterol (HDL-C) is shown to be an independent protective factor against coronary artery diseases (CAD). Yet there are limited studies focusing on the association between HDL-C and coronary artery bypass graft (CABG) surgery outcomes.

HYPOTHESIS

Low levels of HDL-C are associated with higher incidence of adverse outcomes in patients undergoing CABG.

METHODS

This registry-based study included 17,772 patients who underwent elective isolated CABG between 2007 and 2017. Patients were classified into low and desirable HDL-C groups based on their serum HDL-C levels at admission and were followed for one-year post-surgery. The study population included 13,321 patients with low HDL-C and 4,451 with desirable HDL-C. proportional hazard Cox models were performed to evaluate the association between HDL-C levels and incidence of mortality as well as major adverse cardiovascular and cerebrovascular events (MACCE), while adjusting for potential confounders. Moreover, participants were stratified based on sex and the association was also investigated in each subgroup separately.

RESULTS

No significant difference was found between the groups regarding incidence of both mortality and MACCE, after adjusting with Inverse Probability Weighting (IPW) [HR (95%CI): 0.84 (0.46-1.53), p-value:0.575 and HR (95% CI): 0.91 (0.56-1.50), p-value:0.733, respectively]. According to the sex-based subgroup analysis, no significant association was observed after adjustment with IPW analysis. However, as we examined the association between the interaction of HDL-C levels, sex and cardiovascular outcomes, we found a significant association (HR;1.19 (95%CI: 1.04-1.45); p = 0.030).

CONCLUSION

HDL-C level was not associated with either mortality or MACCE during one year after CABG procedure. Sex-based analysis showed that in males, HDL-C is significantly more protective against these outcomes, compared to females. Further studies are necessary to elucidate the exact mechanisms mediating such association.

摘要

背景

高密度脂蛋白胆固醇（HDL-C）被证明是冠心病（CAD）的独立保护因素。然而，目前针对 HDL-C 与冠状动脉旁路移植术（CABG）手术结果之间的关联的研究有限。

假设

HDL-C 水平较低与接受 CABG 手术的患者不良结局的发生率较高有关。

方法

这项基于登记的研究纳入了 2007 年至 2017 年间接受择期单纯 CABG 的 17772 名患者。根据入院时血清 HDL-C 水平，患者被分为低 HDL-C 和理想 HDL-C 组，并在术后一年进行随访。研究人群包括 13321 名低 HDL-C 患者和 4451 名理想 HDL-C 患者。采用比例风险 Cox 模型评估 HDL-C 水平与死亡率和主要不良心血管和脑血管事件（MACCE）发生率之间的关系，同时调整潜在混杂因素。此外，根据性别对参与者进行分层，并分别在每个亚组中研究该关联。

结果

在调整逆概率加权（Inverse Probability Weighting，IPW）后，两组之间死亡率和 MACCE 的发生率均无显著差异[调整后 HR（95%CI）：0.84（0.46-1.53），p 值：0.575 和 HR（95%CI）：0.91（0.56-1.50），p 值：0.733]。根据基于性别的亚组分析，在调整 IPW 分析后，未观察到显著关联。然而，当我们检查 HDL-C 水平、性别与心血管结局之间的相互作用与关联时，我们发现存在显著关联（HR；1.19（95%CI：1.04-1.45）；p=0.030）。