Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China.
Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China; Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China; Laboratory of Cardiac Electrophysiology and Arrhythmia in Guangdong Province, Guangzhou, Guangdong, P.R. China.
Heart Rhythm. 2024 Aug;21(8):1258-1266. doi: 10.1016/j.hrthm.2024.05.044. Epub 2024 May 28.
Atrial fibrillation (AF) is a common arrhythmia with high morbidity and mortality implications. Several studies have described a paradoxical inverse relationship between serum cholesterol and the risk of AF, but it remains unknown whether remnant cholesterol (RC) is associated with AF incidence.
This study aims to prospectively investigate the association between RC and AF.
A total of 392,783 participants free of AF at baseline from the UK Biobank were included for the analysis. Cox proportional hazards model, subgroup analysis, and sensitivity analyses were used to evaluate the independent association between RC levels and the risk of new-onset AF. Furthermore, we performed a discordance analysis by using the median cutoff points of low-density lipoprotein cholesterol (LDL-C) and RC.
After a median follow-up of 12.8 years (interquartile range 12.0-13.6 years), a total of 23,558 participants experienced incident AF. Compared with the highest RC level, the lower RC level was associated with an increased risk of AF incidence (quartile 1 vs quartile 4: hazard ratio 1.396; 95% confidence interval [CI] 1.343-1.452). The results remained robust across a series of sensitivity analyses. In the discordance analyses, a significantly higher risk of AF was observed in participants with discordant low RC/high LDL-C levels than in those with concordant high RC/LDL-C levels. In the low LDL-C group, RC reduction even contributed to an additional 15.8% increased rate of incident AF (low RC/low LDL-C: hazard ratio 1.303; 95% CI 1.260-1.348 vs high RC/low LDL-C: hazard ratio 1.125; 95% CI 1.079-1.172).
Low RC levels were associated with an increased risk of incident AF independent of traditional cardiovascular risk factors.
心房颤动（AF）是一种常见的心律失常，具有较高的发病率和死亡率。几项研究描述了血清胆固醇与 AF 风险之间存在一种矛盾的反比关系，但尚不清楚残余胆固醇（RC）是否与 AF 发病有关。
本研究旨在前瞻性研究 RC 与 AF 之间的关系。
共纳入英国生物库 392783 名基线无 AF 的参与者进行分析。采用 Cox 比例风险模型、亚组分析和敏感性分析评估 RC 水平与新发 AF 风险之间的独立相关性。此外，我们通过使用 LDL-C 和 RC 的中位数截断点进行了不和谐分析。
中位随访 12.8 年（四分位距 12.0-13.6 年）后，共 23558 名参与者发生了 AF。与 RC 最高水平相比，RC 较低水平与 AF 发病风险增加相关（四分位 1 与四分位 4：风险比 1.396；95%置信区间[CI] 1.343-1.452）。一系列敏感性分析的结果仍然稳健。在不和谐分析中，RC/LDL-C 水平不匹配的患者发生 AF 的风险显著高于 RC/LDL-C 水平匹配的患者。在 LDL-C 水平较低的患者中，RC 降低甚至使 AF 发病的额外风险增加了 15.8%（RC/LDL-C 水平较低：风险比 1.303；95%CI 1.260-1.348 vs RC/LDL-C 水平较高：风险比 1.125；95%CI 1.079-1.172）。
RC 水平低与独立于传统心血管危险因素的新发 AF 风险增加相关。
