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血脂标志物在心血管事件预测中的综合评估

Comprehensive Assessment of Lipid Markers in Cardiovascular Events Prediction.

机构信息

Department of Cardiology, Chutoen General Medical Center.

Department of Cardiology, Nagoya University Graduate School of Medicine.

出版信息

Int Heart J. 2024 Sep 30;65(5):792-799. doi: 10.1536/ihj.24-149. Epub 2024 Sep 12.

DOI:10.1536/ihj.24-149
PMID:39261028
Abstract

Many studies have reported a relationship between various lipids, such as cholesterol, fatty acids, and lipoproteins, and cardiovascular events. Low-density lipoprotein cholesterol (LDL-C) is often cited as a representative marker. However, there is still room for discussion regarding which markers, among other lipids, should take clinical precedence.This observational study focused on patients without residual stenosis on post-coronary angiography. It was based on blood tests, including lipid profiles at that time, and assessed the association with the subsequent occurrence of major adverse cardiovascular events (MACE, a composite of all-cause mortality, hospitalization due to heart failure, myocardial infarction, stroke, and all revascularizations).Of the 375 patients analyzed, 134 experienced MACE (median follow-up duration: 1031 days). When comparing the MACE and non-MACE groups, significant differences were observed in lipid markers such as non-high-density lipoprotein cholesterol (non-HDL-C) and remnant-like particle cholesterol (RLP-C) (non-HDL-C; P = 0.003, RLP-C; P < 0.001). Furthermore, the area under the curve for RLP-C was 0.656 (95% CI: 0.598-0.714). Improvement in MACE risk discrimination was observed when LDL-C was replaced with non-HDL-C or RLP-C, in addition to atherosclerosis risk factors (non-HDL-C; net reclassification improvement (NRI) = 0.366, 95% CI: 0.159-0.572, RLP-C; NRI = 0.224, 95% CI: 0.016-0.433).It is highly likely that non-HDL-C and RLP-C can serve as significant lipid markers for predicting the occurrence of MACE.

摘要

许多研究报告了各种脂质,如胆固醇、脂肪酸和脂蛋白,与心血管事件之间的关系。低密度脂蛋白胆固醇(LDL-C)通常被认为是代表性标志物。然而,在其他脂质中,哪些标志物应优先考虑临床应用,仍存在讨论空间。

本观察性研究关注的是冠状动脉造影后无残余狭窄的患者。该研究基于血液测试,包括当时的血脂谱,并评估了其与随后发生的主要不良心血管事件(MACE,全因死亡率、因心力衰竭住院、心肌梗死、卒中和所有血运重建的综合)之间的关联。

在分析的 375 名患者中,有 134 名发生了 MACE(中位随访时间:1031 天)。在比较 MACE 组和非 MACE 组时,在非高密度脂蛋白胆固醇(非 HDL-C)和残粒样颗粒胆固醇(RLP-C)等脂质标志物上观察到显著差异(非 HDL-C;P=0.003,RLP-C;P<0.001)。此外,RLP-C 的曲线下面积为 0.656(95%CI:0.598-0.714)。在用非 HDL-C 或 RLP-C 替代 LDL-C 以及动脉粥样硬化危险因素后,MACE 风险的判别能力得到了改善(非 HDL-C;净重新分类改善(NRI)=0.366,95%CI:0.159-0.572,RLP-C;NRI=0.224,95%CI:0.016-0.433)。

非 HDL-C 和 RLP-C 很可能成为预测 MACE 发生的重要脂质标志物。

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