Li Zhongchen, Yu Chunyu, Zhang Heng, Chen Runze, Zhao Yan, Zheng Zhe
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Rd, Xicheng District, Beijing, 100037, People's Republic of China.
National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Cardiovasc Diabetol. 2025 Jan 8;24(1):8. doi: 10.1186/s12933-024-02537-z.
Remnant cholesterol (remnant-C) contributes to atherosclerotic cardiovascular disease (ASCVD), particularly in individuals with impaired glucose metabolism. Patients with impaired glucose metabolism and ASCVD remain at significant residual risk after coronary artery bypass grafting (CABG). However, the role of remnant-C in this population has not yet been investigated.
Adult patients with prediabetes or diabetes undergoing isolated CABG were consecutively enrolled in a longitudinal cohort between 2013 and 2018. The impact of remnant-C on short-term and long-term outcomes after CABG was evaluated. The short-term outcomes included major perioperative complications. The long-term outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs). Remnant-C was analyzed as both a categorical and continuous variable. Logistic regression, Cox regression, and restricted cubic spline analyses were performed with multivariate adjustments.
In terms of perioperative outcomes, patients with elevated remnant-C had a higher incidence of acute kidney injury (AKI) stage 2/3 (high vs. low remnant-C: 3.2% vs. 2.4%; OR: 1.404, 95% CI 1.080-1.824). Each 1-standard deviation (SD) increase in remnant-C was associated with a 16.6% higher risk of AKI stage 2/3 (OR: 1.160, 95% CI 1.067-1.260). Long-term outcomes were assessed after a median follow-up of 3.2 years, during which 1,251 patients (9.3%) experienced MACCEs. Each 1-SD increase in remnant-C was associated with a 6.6% higher risk of MACCEs (HR: 1.066, 95% CI 1.012-1.124), a 7.1% higher risk of all-cause death (HR: 1.071, 95% CI 1.008-1.209), and an 11.2% higher risk of myocardial infarction (HR: 1.112, 95% CI 1.011-1.222). These associations remained consistent when remnant-C was treated as a categorical variable. Importantly, the association between remnant-C and MACCEs was independent of LDL-C levels; higher remnant-C levels were associated with increased MACCE risk regardless of whether LDL-C was ≤ 2.6 mmol/L or > 2.6 mmol/L. Subgroup analysis indicated that this risk was more pronounced in insulin-treated patients.
Remnant-C is associated with AKI and MACCEs in patients with diabetes or prediabetes undergoing CABG. The MACCE risk associated with remnant-C is independent of LDL-C and is more pronounced in insulin-treated patients.
残余胆固醇（remnant-C）会导致动脉粥样硬化性心血管疾病（ASCVD），在糖代谢受损的个体中尤为如此。糖代谢受损且患有ASCVD的患者在冠状动脉旁路移植术（CABG）后仍存在显著的残余风险。然而，remnant-C在该人群中的作用尚未得到研究。
2013年至2018年期间，连续纳入接受单纯CABG的成年糖尿病前期或糖尿病患者进入纵向队列。评估remnant-C对CABG术后短期和长期结局的影响。短期结局包括主要围手术期并发症。长期结局为主要不良心血管和脑血管事件（MACCEs）。将remnant-C作为分类变量和连续变量进行分析。进行多变量调整的逻辑回归、Cox回归和受限立方样条分析。
在围手术期结局方面，remnant-C升高的患者急性肾损伤（AKI）2/3期的发生率更高（高remnant-C组与低remnant-C组：3.2%对2.4%；OR：1.404，95%CI 1.080-1.824）。remnant-C每增加1个标准差（SD），AKI 2/3期的风险升高16.6%（OR：1.160，95%CI 1.067-1.260）。中位随访3.2年评估长期结局，在此期间1251例患者（9.3%）发生MACCEs。remnant-C每增加1个SD，MACCEs风险升高6.6%（HR：1.066，95%CI 1.012-1.124），全因死亡风险升高7.1%（HR：1.071，95%CI 1.008-1.209），心肌梗死风险升高11.2%（HR：1.112，95%CI 1.011-1.222）。当将remnant-C作为分类变量处理时，这些关联仍然一致。重要的是，remnant-C与MACCEs之间的关联独立于低密度脂蛋白胆固醇（LDL-C）水平；无论LDL-C是≤2.6 mmol/L还是>2.6 mmol/L，较高的remnant-C水平均与MACCEs风险增加相关。亚组分析表明，这种风险在接受胰岛素治疗的患者中更为明显。
remnant-C与接受CABG的糖尿病或糖尿病前期患者的AKI和MACCEs相关。与remnant-C相关的MACCEs风险独立于LDL-C，且在接受胰岛素治疗的患者中更为明显。
