青年期血脂谱的变异性与中年冠心病钙沉积风险的关系：来自 CARDIA 研究的见解。
Variability in Lipid Profiles During Young Adulthood and the Risk of Coronary Artery Calcium Incidence in Midlife: Insights From the CARDIA Study.
机构信息
Department of Cardiology (J.-W.G., Z.-G.H., H.-F.Z., Y.-B.W., Z.-C.X., S.Y., J.-F.W., P.-M.L.) Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China (Q.-Y.H., Z.-H.L.).
出版信息
Circ Cardiovasc Imaging. 2024 Sep;17(9):e016842. doi: 10.1161/CIRCIMAGING.123.016842. Epub 2024 Sep 13.
BACKGROUND
Intraindividual variability in lipid profiles is recognized as a potential predictor of cardiovascular events. However, the influence of early adulthood lipid profile variability along with mean lipid levels on future coronary artery calcium (CAC) incidence remains unclear.
METHODS
A total of 2395 participants (41.6% men; mean±SD age, 40.2±3.6 years) with initial CAC =0 from the CARDIA study (Coronary Artery Risk Development in Young Adults) were included. Serial lipid measurements were obtained to calculate mean levels and variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides. CAC incidence was defined as CAC >0 at follow-up.
RESULTS
During a mean follow-up of 9.0 years, 534 individuals (22.3%) exhibited CAC incidence. Higher mean levels of total cholesterol, LDL-C, and non-HDL-C were associated with a greater risk of future CAC incidence. Similarly, 1-SD increment of lipid variability, as assessed by variability independent of the mean, was associated with an increased risk of CAC incidence (LDL-C: hazard ratio, 1.139 [95% CI, 1.048-1.238]; =0.002; non-HDL-C: hazard ratio, 1.102 [95% CI, 1.014-1.198]; =0.022; and triglycerides: hazard ratio, 1.480 [95% CI, 1.384-1.582]; <0.001). Combination analyses demonstrated that participants with both high lipid levels and high variability in lipid profiles (LDL-C and non-HDL-C) faced the greatest risk of CAC incidence. Specifically, elevated variability of LDL-C was associated with an additional risk of CAC incidence even in low mean levels of LDL-C (hazard ratio, 1.396 [95% CI, 1.106-1.763]; =0.005). These findings remained robust across a series of sensitivity and subgroup analyses.
CONCLUSIONS
Elevated variability in LDL-C and non-HDL-C during young adulthood was associated with an increased risk of CAC incidence in midlife, especially among those with high mean levels of atherogenic lipoproteins. These findings highlight the importance of maintaining consistently low levels of atherogenic lipids throughout early adulthood to reduce subclinical atherosclerosis in midlife.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.
背景
个体内脂质谱的变异性被认为是心血管事件的潜在预测因子。然而，早期成年期脂质谱变异性与平均脂质水平对未来冠状动脉钙（CAC）发生率的影响仍不清楚。
方法
共纳入 2395 名来自 CARDIA 研究（年轻人冠状动脉风险发展研究）的初始 CAC =0 的参与者（41.6%为男性；平均年龄±标准差为 40.2±3.6 岁）。连续测量脂质以计算总胆固醇、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（非-HDL-C）和甘油三酯的平均水平和变异性。CAC 发生率定义为随访时 CAC>0。
结果
在平均 9.0 年的随访期间，534 名参与者（22.3%）发生 CAC 事件。总胆固醇、LDL-C 和非-HDL-C 的平均水平较高与未来 CAC 发生率增加相关。同样，以均值独立变异评估的脂质变异性每增加 1-SD，与 CAC 发生率增加相关（LDL-C：风险比，1.139 [95%CI，1.048-1.238]；=0.002；非-HDL-C：风险比，1.102 [95%CI，1.014-1.198]；=0.022；和甘油三酯：风险比，1.480 [95%CI，1.384-1.582]；<0.001）。组合分析表明，脂质水平高且脂质谱（LDL-C 和非-HDL-C）变异性高的参与者 CAC 发生率最高。具体而言，即使 LDL-C 的平均水平较低，升高的 LDL-C 变异也与 CAC 发生率的额外风险相关（风险比，1.396 [95%CI，1.106-1.763]；=0.005）。这些发现通过一系列敏感性和亚组分析仍然稳健。
结论
在年轻成年期间 LDL-C 和非-HDL-C 的变异性增加与中年 CAC 发生率增加相关，尤其是在那些具有高致动脉粥样硬化脂蛋白平均水平的人群中。这些发现强调了在整个早期成年期保持致动脉粥样硬化脂质水平持续降低以减少中年亚临床动脉粥样硬化的重要性。
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