降脂治疗对脂质相关残余风险因素的影响：一项前瞻性研究。

The effect of lipid-lowering therapy on lipid-related residual risk factors: a prospective study.

机构信息

Cardiometabolic Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China.

出版信息

Lipids Health Dis. 2024 May 7;23(1):134. doi: 10.1186/s12944-024-02078-0.

DOI:10.1186/s12944-024-02078-0

PMID:38715079

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11075277/

Abstract

BACKGROUND

Remnant cholesterol (RC) and nonhigh-density lipoprotein cholesterol (nonHDL-C) are key risk factors for atherosclerotic cardiovascular disease (ASCVD), with apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)] also contributing to its residual risk. However, real-world population-based evidence regarding the impact of current clinical LDL-C-centric lipid-lowering therapy (LLT) on achieving RC and nonHDL-C goals, as well as on modifying residual CVD risk factors is limited.

METHODS

This prospective observational study enrolled 897 CVD patients from September, 2020 to July, 2021. All participants had previously received low-/moderate-intensity LLT and were discharged with either low-/moderate-intensity LLT or high-intensity LLT. After a median follow-up of 3 months, changes in RC, nonHDL-C, and other biomarkers were assessed. Multivariate logistic regression was performed to analyze the impact of the LLT on goal attainment.

RESULTS

Among all patients, 83.50% transitioned to high-intensity LLT from low or moderate. After follow-up, the high-intensity group saw significantly greater reductions in RC (-20.51% vs. -3.90%, P = 0.025), nonHDL-C (-25.12% vs. 0.00%, P < 0.001), apoB (-19.35% vs. -3.17%, P < 0.001), triglycerides (-17.82% vs. -6.62%, P < 0.001), and LDL-C and total cholesterol. Spearman correlation analysis revealed that LDL-C reduction from current LLT was strongly correlated with nonHDL-C reduction (r = 0.87, P < 0.001). Patients who received high-intensity LLT had significant improvements in attainment of RC (from 44.2% to 60.7%, χ² = 39.23, P < 0.001) and nonHDL-C (from 19.4% to 56.9%, χ² = 226.06, P < 0.001) goals. Furthermore, multivariate logistic regression showed that high-intensity LLT was a protective factor for RC [odds ratio (OR) = 0.66; 95% confidence intervals (CI), 0.45-0.97; P = 0.033] and nonHDL-C goal attainment (OR = 0.51; 95% CI, 0.34-0.75; P < 0.001), without a significant increase of adverse reactions.

CONCLUSION

Current levels of clinically prescribed LDL-C-centric treatment can reduce RC and other lipid-related residual risk factors, but high-intensity LLT is better at achieving nonHDL-C and RC goals than low-/moderate-intensity LLT, with a good safety profile. More targeted RC treatments are still needed to reduce residual lipid risk further.

摘要

背景

残余胆固醇（RC）和非高密度脂蛋白胆固醇（nonHDL-C）是动脉粥样硬化性心血管疾病（ASCVD）的关键风险因素，载脂蛋白 B（apoB）和脂蛋白（a）[Lp(a)]也有助于其残余风险。然而，目前基于人群的关于当前临床 LDL-C 为中心的降脂治疗（LLT）对实现 RC 和 nonHDL-C 目标的影响，以及对改善残余 CVD 风险因素的影响的实际证据有限。

方法

这项前瞻性观察研究纳入了 2020 年 9 月至 2021 年 7 月期间的 897 例 CVD 患者。所有患者均接受过低/中强度 LLT，并接受低/中强度 LLT 或高强度 LLT 出院。中位随访 3 个月后，评估 RC、nonHDL-C 和其他生物标志物的变化。采用多变量逻辑回归分析 LLT 对目标实现的影响。

结果

在所有患者中，83.50%从低或中强度过渡到高强度 LLT。随访后，高强度组的 RC（-20.51%比-3.90%，P=0.025）、nonHDL-C（-25.12%比 0.00%，P<0.001）、apoB（-19.35%比-3.17%，P<0.001）、甘油三酯（-17.82%比-6.62%，P<0.001）和 LDL-C 和总胆固醇的降幅明显更大。Spearman 相关分析显示，当前 LLT 降低 LDL-C 与降低 nonHDL-C 呈强相关（r=0.87，P<0.001）。接受高强度 LLT 的患者在实现 RC（从 44.2%到 60.7%，χ²=39.23，P<0.001）和 nonHDL-C（从 19.4%到 56.9%，χ²=226.06，P<0.001）目标方面有显著改善。此外，多变量逻辑回归显示，高强度 LLT 是 RC[比值比（OR）=0.66；95%置信区间（CI），0.45-0.97；P=0.033]和 nonHDL-C 目标实现（OR=0.51；95%CI，0.34-0.75；P<0.001）的保护因素，且不良反应无显著增加。