Faridi Kamil F, Lahan Shubham, Budoff Matthew J, Cury Ricardo C, Feldman Theodore, Pan Alan P, Fialkow Jonathan, Nasir Khurram
Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
JACC Adv. 2024 Jun 13;3(7):101049. doi: 10.1016/j.jacadv.2024.101049. eCollection 2024 Jul.
BACKGROUND: The relationship between atherogenic lipoproteins and subclinical coronary atherosclerosis has not been thoroughly evaluated in low-risk adults. OBJECTIVES: The purpose of this study was to assess the association of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B (apoB) with coronary atherosclerosis in adults without traditional risk factors. METHODS: We assessed atherosclerosis on coronary computed tomography angiography among asymptomatic adults in the Miami Heart Study not taking lipid-lowering therapy and without hypertension, diabetes, or active tobacco use. Prevalence of atherosclerosis was evaluated based on serum LDL-C, non-HDL-C, and apoB, and multivariable logistic regression with forward selection was used to assess variables associated with coronary plaque. RESULTS: Among 1,033 adults 40 to 65 years of age, 55.0% were women and 86.3% had estimated 10-year atherosclerotic cardiovascular disease risk <5%. Coronary atherosclerosis prevalence was 35.9% (50.6% in men; 23.8% in women) and 3.4% had ≥1 high-risk plaque feature. Atherosclerosis prevalence increased with LDL-C, ranging from 13.2% in adults with LDL-C <70 mg/dL up to 48.2% with ≥160 mg/dL. Higher LDL-C (adjusted OR [aOR]: 1.13 [95% CI: 1.08-1.18] per 10 mg/dL), age (aOR: 1.43 [95% CI: 1.28-1.60] per 5 years), male sex (aOR: 3.81 [95% CI: 2.86-5.10]), and elevated lipoprotein(a) (aOR: 1.46 [95% CI: 1.01-2.09]) were associated with atherosclerosis. Higher serum non-HDL-C and apoB were similarly associated with atherosclerosis. In adults with optimal risk factors, 21.2% had atherosclerosis with greater prevalence at higher lipoprotein levels. CONCLUSIONS: Among asymptomatic middle-aged adults without traditional risk factors, coronary atherosclerosis is common and increasingly prevalent at higher levels of atherogenic lipoproteins. These findings emphasize the importance of lipid-lowering strategies to prevent development and progression of atherosclerosis regardless of risk factors.
背景：在低风险成年人中，致动脉粥样硬化脂蛋白与亚临床冠状动脉粥样硬化之间的关系尚未得到充分评估。 目的：本研究的目的是评估低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（HDL-C）和载脂蛋白B（apoB）与无传统危险因素的成年人冠状动脉粥样硬化的关联。 方法：在迈阿密心脏研究中，我们对未接受降脂治疗、无高血压、糖尿病或当前不吸烟的无症状成年人进行冠状动脉计算机断层扫描血管造影，以评估动脉粥样硬化情况。根据血清LDL-C、非HDL-C和apoB评估动脉粥样硬化的患病率，并采用向前选择的多变量逻辑回归来评估与冠状动脉斑块相关的变量。 结果：在1033名40至65岁的成年人中，55.0%为女性，86.3%的人估计10年动脉粥样硬化性心血管疾病风险<5%。冠状动脉粥样硬化患病率为35.9%（男性为50.6%；女性为23.8%），3.4%的人有≥1个高危斑块特征。动脉粥样硬化患病率随LDL-C升高而增加，LDL-C<70mg/dL的成年人中患病率为13.2%，≥160mg/dL的成年人中患病率高达48.2%。较高的LDL-C（每10mg/dL调整后的比值比[aOR]：1.13[95%置信区间：1.08-1.18]）、年龄（每5年aOR：1.43[95%置信区间：1.28-1.60]）、男性（aOR：3.81[95%置信区间：2.86-5.10]）和脂蛋白(a)升高（aOR：1.46[95%置信区间：1.01-2.09]）与动脉粥样硬化相关。较高的血清非HDL-C和apoB与动脉粥样硬化也有类似关联。在具有最佳危险因素的成年人中，21.2%患有动脉粥样硬化，在较高脂蛋白水平时患病率更高。 结论：在无传统危险因素的无症状中年成年人中，冠状动脉粥样硬化很常见，且在致动脉粥样硬化脂蛋白水平较高时患病率增加。这些发现强调了降脂策略对于预防动脉粥样硬化发生和进展的重要性，无论有无危险因素。
Curr Diab Rep. 2019-11-21
Curr Cardiol Rep. 2025-6-25
Environ Health Prev Med. 2025
JACC Cardiovasc Imaging. 2023-1
JACC Cardiovasc Imaging. 2022-9
J Am Coll Cardiol. 2021-10-19
Circulation. 2021-9-21
Circulation. 2021-9-28
Zotero 插件
