Department of Cardiology, Chutoen General Medical Center.
Department of Cardiology, Nagoya University Graduate School of Medicine.
Int Heart J. 2024 Sep 30;65(5):792-799. doi: 10.1536/ihj.24-149. Epub 2024 Sep 12.
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.
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。