Peng Zhaoxi, Qiu Peng, Guo Hongbin, Zhu Chao, Zheng Jiazhen, Pu Hongji, Liu Yijun, Wei Weiqing, Li ChenShu, Yang Xinrui, Ye Kaichuang, Wang Ruihua, Lu Xinwu, Zhou Zhen
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Australia.
J Vasc Surg. 2025 Apr;81(4):894-904.e6. doi: 10.1016/j.jvs.2024.12.004. Epub 2024 Dec 16.
Whether high-density lipoprotein cholesterol (HDL-C) has a protective role against abdominal aortic aneurysm (AAA) development in both older males and females remains uncertain. This study aims to assess the sex-specific association between HDL-C and incident AAA in older adults from the UK Biobank.
This cohort study included 86,184 males and 95,682 females aged ≥60 years from the UK biobank. Baseline HDL-C was modelled either as a continuous or categorical variable. The primary outcome was incident AAA. Cox proportional hazard models were used for sex-stratified analysis, adjusting for baseline confounders. Restricted cubic splines were plotted to visualize any nonlinear relationship. Harrell's C-index was calculated to assess the added value of HDL-C to the discrimination of model including age and smoking.
Over a mean follow-up of 14.4 years, 1549 and 328 incident AAA were observed in males and females, respectively. Adjusted hazard ratios for AAA with a 1-mmol/L HDL-C increase was 0.26 (95% confidence interval, 0.21- 0.32) and 0.31 (95% confidence interval, 0.21-0.46) in males and females, respectively (both P < .001). Consistent with the results from Cox model modelling HDL-C as a categorical variable showing an inverse and dose-dependent relationship between HDL-C and incident AAA in both sexes, restricted cubic splines confirmed the monotonic, inverse associations. Adding HDL-C to a model including age and smoking significantly improve the model discrimination for AAA in both sexes (C-index +2.1% in males and +1.5% in females; both P < .05).
This study revealed a significant association between low HDL-C levels and a high risk of incident AAA in both older males and females, suggesting the potential clinical usefulness of HDL-C for AAA risk stratification. Our study was limited by its observational design and the presence of possible residual confounding. Studies using real-world data are warranted to evaluate the practical implications of incorporating HDL-C into AAA screening guidelines and its impact on patient outcomes.
高密度脂蛋白胆固醇（HDL-C）对老年男性和女性腹主动脉瘤（AAA）的发生是否具有保护作用仍不确定。本研究旨在评估英国生物银行中老年人HDL-C与新发AAA之间的性别特异性关联。
这项队列研究纳入了英国生物银行中86184名年龄≥60岁的男性和95682名年龄≥60岁的女性。基线HDL-C被建模为连续变量或分类变量。主要结局是新发AAA。采用Cox比例风险模型进行性别分层分析，并对基线混杂因素进行调整。绘制受限立方样条以可视化任何非线性关系。计算Harrell's C指数以评估HDL-C对包含年龄和吸烟因素的模型鉴别能力的增加值。
在平均14.4年的随访中，男性和女性分别观察到1549例和328例新发AAA。HDL-C每增加1 mmol/L，男性和女性AAA的调整后风险比分别为0.26（95%置信区间，0.21 - 0.32）和0.31（95%置信区间，0.21 - 0.46）（均P < .001）。将HDL-C作为分类变量进行Cox模型建模的结果一致显示，HDL-C与两性新发AAA之间存在反向和剂量依赖性关系，受限立方样条证实了这种单调的反向关联。在包含年龄和吸烟因素的模型中加入HDL-C显著提高了模型对两性AAA的鉴别能力（男性C指数增加2.1%，女性增加1.5%；均P < .05）。
本研究揭示了老年男性和女性中低HDL-C水平与高新发AAA风险之间存在显著关联，提示HDL-C在AAA风险分层中具有潜在的临床应用价值。我们的研究受限于其观察性设计以及可能存在的残余混杂因素。有必要开展使用真实世界数据的研究，以评估将HDL-C纳入AAA筛查指南的实际意义及其对患者结局的影响。
