Wilkins John T, Ning Hongyan, Allen Norrina B, Zheutlin Alexander, Shah Nilay S, Feinstein Matthew J, Perak Amanda M, Khan Sadiya S, Bhatt Ankeet S, Shah Ravi, Murthy Venkatesh, Sniderman Allan, Lloyd-Jones Donald M
Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine (Epidemiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Preventive Medicine (Epidemiology), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Am Coll Cardiol. 2024 Sep 10;84(11):961-973. doi: 10.1016/j.jacc.2024.05.070.
The ability of a 1-time measurement of non-high-density lipoprotein cholesterol (non-HDL-C) or low-density lipoprotein cholesterol (LDL-C) to predict the cumulative exposure to these lipids during early adulthood (age 18-40 years) and the associated atherosclerotic cardiovascular disease (ASCVD) risk after age 40 years is not clear.
The objectives of this study were to evaluate whether a 1-time measurement of non-HDL-C or LDL-C in a young adult can predict cumulative exposure to these lipids during early adulthood, and to quantify the association between cumulative exposure to non-HDL-C or LDL-C during early adulthood and the risk of ASCVD after age 40 years.
We included CARDIA (Coronary Artery Risk Development in Young Adults Study) participants who were free of cardiovascular disease before age 40 years, were not taking lipid-lowering medications, and had ≥3 measurements of LDL-C and non-HDL-C before age 40 years. First, we assessed the ability of a 1-time measurement of LDL-C or non-HDL-C obtained between age 18 and 30 years to predict the quartile of cumulative lipid exposure from ages 18 to 40 years. Second, we assessed the associations between quartiles of cumulative lipid exposure from ages 18 to 40 years with ASCVD events (fatal and nonfatal myocardial infarction and stroke) after age 40 years.
Of 4,104 CARDIA participants who had multiple lipid measurements before and after age 30 years, 3,995 participants met our inclusion criteria and were in the final analysis set. A 1-time measure of non-HDL-C and LDL-C had excellent discrimination for predicting membership in the top or bottom quartiles of cumulative exposure (AUC: 0.93 for the 4 models). The absolute values of non-HDL-C and LDL-C that predicted membership in the top quartiles with the highest simultaneous sensitivity and specificity (highest Youden's Index) were >135 mg/dL for non-HDL-C and >118 mg/dL for LDL-C; the values that predicted membership in the bottom quartiles were <107 mg/dL for non-HDL-C and <96 mg/dL for LDL-C. Individuals in the top quartile of non-HDL-C and LDL-C exposure had demographic-adjusted HRs of 4.6 (95% CI: 2.84-7.29) and 4.0 (95% CI: 2.50-6.33) for ASCVD events after age 40 years, respectively, when compared with each bottom quartile.
Single measures of non-HDL-C and LDL-C obtained between ages 18 and 30 years are highly predictive of cumulative exposure before age 40 years, which in turn strongly predicts later-life ASCVD events.
单次测量非高密度脂蛋白胆固醇（non-HDL-C）或低密度脂蛋白胆固醇（LDL-C）能否预测成年早期（18 - 40岁）这些脂质的累积暴露情况以及40岁后相关的动脉粥样硬化性心血管疾病（ASCVD）风险尚不清楚。
本研究的目的是评估在年轻成年人中单次测量non-HDL-C或LDL-C能否预测成年早期这些脂质的累积暴露情况，并量化成年早期non-HDL-C或LDL-C的累积暴露与40岁后ASCVD风险之间的关联。
我们纳入了CARDIA（年轻成年人冠状动脉风险发展研究）的参与者，这些参与者在40岁之前无心血管疾病，未服用降脂药物，且在40岁之前有≥3次LDL-C和non-HDL-C测量值。首先，我们评估在18至30岁之间获得的单次LDL-C或non-HDL-C测量值预测18至40岁累积脂质暴露四分位数的能力。其次，我们评估18至40岁累积脂质暴露四分位数与40岁后ASCVD事件（致命和非致命心肌梗死及中风）之间的关联。
在4104名30岁前后进行多次脂质测量的CARDIA参与者中，3995名参与者符合我们的纳入标准并纳入最终分析集。单次测量non-HDL-C和LDL-C在预测累积暴露的上四分位数或下四分位数归属方面具有出色的辨别能力（4个模型的AUC：0.93）。预测上四分位数归属且同时具有最高灵敏度和特异性（最高约登指数）的non-HDL-C和LDL-C绝对值分别为non-HDL-C >135 mg/dL和LDL-C >118 mg/dL；预测下四分位数归属的值分别为non-HDL-C <107 mg/dL和LDL-C <96 mg/dL。与每个下四分位数相比，non-HDL-C和LDL-C暴露上四分位数的个体在40岁后发生ASCVD事件的经人口统计学调整的HR分别为4.6（95%CI：2.
