Li Chuang, He Kuizheng, Yang Yixing, Li Kuibao, Chen Mulei, Wang Lefeng, Gao Yuanfeng, Xu Xiaorong
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China.
Rev Cardiovasc Med. 2023 Sep 21;24(9):263. doi: 10.31083/j.rcm2409263. eCollection 2023 Sep.
Some individuals who maintain desirable low-density lipoprotein cholesterol (LDL-C) levels still experience the progression of atherosclerosis, which may eventually lead to cardiovascular events. Non-high-density lipoprotein cholesterol (non-HDL-C) levels are quantified to assess residual risk in statin-treated patients with coronary heart disease. The study aimed to estimate the predictive performance of discordance between non-HDL-C and LDL-C on clinical prognosis in statin-treated patients with previous coronary artery bypass grafting (CABG).
468 statin-treated patients with previous CABG undergoing percutaneous coronary intervention (PCI) as a secondary coronary treatment due to acute coronary syndrome (ACS) were retrospectively enrolled in this study. The definition of major adverse cardiovascular events (MACEs) was a composite endpoint of cardiovascular death, recurring myocardial infarction, and a need for repeat revascularization. Cox proportional hazards modeling, restricted cubic splines regression, and discordance analysis were conducted to the association between all lipid parameters and the occurrence of MACEs. Discordant values were defined as LDL-C concentrations 1.8 mmol/L accompanied by non-HDL-C 2.6 mmol/L.
MACEs occurred in 95 patients over a median follow-up period of 744.5 days. Cox models demonstrated that increased concentrations of non-HDL-C and LDL-C levels were independent risk indicators of MACEs ( 0.001). The restricted cubic spline analysis revealed a linear relationship between non-HDL-C concentrations and MACEs (p-nonlinear: 0.26), whereas a nonlinear relationship was observed between LDL-C concentrations and MACEs ( 0.01). In the subgroup analysis, the spline curves revealed that the odds of the individuals with desirable LDL-C levels suffering MACEs emerged when non-HDL-C levels were above 2.07 mmol/L. Individuals who exhibited discordance involving high non-HDL-C/low LDL-C levels had an elevated risk of experiencing MACEs compared to those with concordantly low LDL-C and low non-HDL-C levels [hazard ratios (HRs) = 2.44, 95% confidence interval (CI) = 1.14-5.22, = 0.02].
Non-HDL-C levels could predict the residual risk of MACEs in ACS patients with previous CABG and statin therapy that underwent percutaneous coronary intervention. A discordance between non-HDL-C and LDL-C in individuals with desirable LDL-C levels could be useful in identifying those with a residual risk of cardiovascular complications.
一些低密度脂蛋白胆固醇（LDL-C）水平维持在理想范围的个体仍会出现动脉粥样硬化进展，最终可能导致心血管事件。非高密度脂蛋白胆固醇（non-HDL-C）水平用于评估接受他汀类药物治疗的冠心病患者的残余风险。本研究旨在评估non-HDL-C与LDL-C之间的不一致对既往接受冠状动脉旁路移植术（CABG）且接受他汀类药物治疗患者临床预后的预测价值。
本研究回顾性纳入了468例既往接受CABG且因急性冠状动脉综合征（ACS）接受经皮冠状动脉介入治疗（PCI）的他汀类药物治疗患者。主要不良心血管事件（MACE）的定义为心血管死亡、复发性心肌梗死和再次血运重建需求的复合终点。采用Cox比例风险模型、受限立方样条回归和不一致性分析评估所有血脂参数与MACE发生之间的关联。不一致值定义为LDL-C浓度<1.8 mmol/L且non-HDL-C>2.6 mmol/L。
在中位随访期744.5天内，95例患者发生了MACE。Cox模型显示，non-HDL-C和LDL-C水平升高是MACE的独立风险指标（P<0.001）。受限立方样条分析显示，non-HDL-C浓度与MACE之间存在线性关系（P非线性=0.26），而LDL-C浓度与MACE之间存在非线性关系（P<0.01）。在亚组分析中，样条曲线显示，当non-HDL-C水平高于2.07 mmol/L时，LDL-C水平理想的个体发生MACE的几率增加。与LDL-C和non-HDL-C水平均低的个体相比，non-HDL-C高/LDL-C低水平不一致的个体发生MACE的风险升高[风险比（HR）=2.44，95%置信区间（CI）=1.14-5.22，P=0.02]。
non-HDL-C水平可预测既往接受CABG且接受他汀类药物治疗并接受经皮冠状动脉介入治疗的ACS患者发生MACE的残余风险。LDL-C水平理想的个体中，non-HDL-C与LDL-C之间的不一致有助于识别有心血管并发症残余风险的患者。
