Department of Nutrition and Food Hygiene, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Major Chronic Non-communicable Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, China.
Vanke School of Public Health, Tsinghua University, Beijing, China.
J Lipid Res. 2024 Nov;65(11):100653. doi: 10.1016/j.jlr.2024.100653. Epub 2024 Sep 20.
Triglyceride-rich lipoproteins cholesterol (TRLs-C) has been associated with atherosclerotic cardiovascular disease (ASCVD), even among individuals with low-density lipoprotein cholesterol in the targeted range. We assessed the associations of TRLs-C with myocardial infarction (MI) and ischemic stroke (IS) and compared the associations with those for other traditional lipids (i.e., triglycerides and non-high-density lipoprotein cholesterol [non-HDL-C]). Included were 327,899 participants from the UK Biobank who were free of MI or IS and did not receive lipid-lowering treatment at baseline. Ten-year risk for ASCVD was estimated by the Pooled Cohort Equations and was grouped as low (<7.5%), intermediate (7.5% to <20%), and high risk (≥20%). Multivariable Cox regression models were used to examine the associations of TRLs-C, triglycerides, and non-HDL-C with risk of MI and IS, overall and by the 10-years risk categories. During a median of 12.3 years of follow-up, 8,358 incident MI and 4,400 incident IS cases were identified. After multivariable adjustment, higher TRLs-C was associated with a higher risk of MI (p-trend <0.0001) but not IS (p-trend = 0.074), with similar associations for triglycerides and non-HDL-C. There were interactions between TRLs-C and 10-years ASCVD risk on risk of MI (p-interaction <0.0001) and IS (p-interaction = 0.0003). Hazard ratios (95% CIs) of MI comparing the highest with the lowest quartiles of TRLs-C were 2.10 (1.23-1.30) in the low-risk group, 1.52 (1.38-1.69) in the intermediate-risk group, and 1.22 (1.03-1.45) in the high-risk group. The corresponding estimates for IS were 1.24 (1.05-1.45), 0.94 (0.83-1.07), and 0.83 (0.67-1.04), respectively. Similar interactions with the 10-years ASCVD risk were observed for triglycerides and non-HDL-C on risk of MI and for triglycerides on risk of IS. Elevated levels of TRLs-C (or triglycerides or non-HDL-C) are associated with a higher risk of developing MI and IS (except non-HDL-C) predominantly among individuals who are typically classified as being low-risk. These findings may have implications for more detailed risk stratification and early intervention.
富含甘油三酯的脂蛋白胆固醇（TRLs-C）与动脉粥样硬化性心血管疾病（ASCVD）相关，即使在低密度脂蛋白胆固醇处于目标范围内的个体中也是如此。我们评估了 TRLs-C 与心肌梗死（MI）和缺血性卒中（IS）的相关性，并比较了与其他传统脂质（即甘油三酯和非高密度脂蛋白胆固醇[非 HDL-C]）的相关性。纳入了英国生物库 327899 名无 MI 或 IS 且基线时未接受降脂治疗的参与者。通过汇总队列方程估计 10 年 ASCVD 风险，并将其分为低危（<7.5%）、中危（7.5%至<20%）和高危（≥20%）。多变量 Cox 回归模型用于检查 TRLs-C、甘油三酯和非 HDL-C 与 MI 和 IS 风险的相关性，包括整体风险和按 10 年风险类别进行的风险。在中位随访 12.3 年期间，确定了 8358 例 MI 和 4400 例 IS 事件。经多变量调整后，较高的 TRLs-C 与 MI 风险增加相关（趋势检验 p<0.0001），但与 IS 风险无关（趋势检验 p=0.074），甘油三酯和非 HDL-C 也有类似的相关性。TRLs-C 与 10 年 ASCVD 风险之间存在 MI（交互作用 p<0.0001）和 IS（交互作用 p=0.0003）风险的交互作用。与 TRLs-C 最高四分位与最低四分位相比，MI 的风险比（95%CI）在低危组为 2.10（1.23-1.30），中危组为 1.52（1.38-1.69），高危组为 1.22（1.03-1.45）。IS 的相应估计值分别为 1.24（1.05-1.45）、0.94（0.83-1.07）和 0.83（0.67-1.04）。对于 MI 风险，甘油三酯和非 HDL-C 以及 IS 风险的甘油三酯均观察到与 10 年 ASCVD 风险的类似交互作用。TRLs-C（或甘油三酯或非 HDL-C）水平升高与 MI 和 IS（非 HDL-C 除外）风险增加相关，主要发生在通常被归类为低危的个体中。这些发现可能对更详细的风险分层和早期干预具有重要意义。
