残余胆固醇与不健康生活方式及冠心病风险的关联：一项基于人群的队列研究。
Association of remnant cholesterol with unhealthy lifestyle and risk of coronary heart disease: a population-based cohort study.
作者信息
Johansen Mia Ø, Vedel-Krogh Signe, Nielsen Sune F, Afzal Shoaib, Davey Smith George, Nordestgaard Børge G
机构信息
Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Denmark.
The Copenhagen General Population Study, Copenhagen University Hospital - Herlev and Gentofte, Denmark.
出版信息
Lancet Reg Health Eur. 2025 Feb 7;51:101223. doi: 10.1016/j.lanepe.2025.101223. eCollection 2025 Apr.
BACKGROUND
Unhealthy lifestyle is a major risk factor for coronary heart disease, which may be explained by elevated remnant cholesterol. However, this question remains incompletely clarified. In this study, we aimed to investigate whether elevated remnant cholesterol explains part of the excess risk of myocardial infarction and coronary heart disease in individuals with unhealthy lifestyle.
METHODS
We included 104,867 individuals (58,286 women and 46,581 men) from the Copenhagen General Population Study free from coronary heart disease at examination. During a median follow-up of 9.2 years, 2484 developed myocardial infarction and 3570 developed coronary heart disease. To understand explained risk from elevated remnant cholesterol due to unhealthy lifestyle on risk of myocardial infarction and coronary heart disease, we used mediation analyses.
FINDINGS
Current smoking, low physical activity, and low adherence to dietary guidelines were all associated with higher levels of remnant cholesterol. For current smoking, remnant cholesterol explained 15% (95% confidence interval: 9.7%-20%) of the excess risk of myocardial infarction and 16% (11%-21%) of the excess risk of coronary heart disease. Corresponding values for low physical activity were 20% (13%-27%) and 21% (15%-28%), and for low adherence to dietary guidelines 12% (6.6%-18%) and 14% (8.0%-19%), respectively. Results were similar in women and men separately and in analyses where each lifestyle factor were additionally adjusted for the other three lifestyle factors.
INTERPRETATION
Elevated remnant cholesterol explained part of excess myocardial infarction and coronary heart disease in individuals with an unhealthy lifestyle. Clinically, these novel findings underline the importance of both elevated remnant cholesterol and promotion of healthy lifestyle in primary prevention of myocardial infarction and coronary heart disease.
FUNDING
Independent Research Fund Denmark; Johan Boserup and Lise Boserups Grant; Medical Research Council.
背景
不健康的生活方式是冠心病的主要危险因素，这可能可以通过残余胆固醇升高来解释。然而，这个问题仍未完全阐明。在本研究中，我们旨在调查残余胆固醇升高是否能解释不健康生活方式个体中部分额外的心肌梗死和冠心病风险。
方法
我们纳入了哥本哈根普通人群研究中的104867名个体（58286名女性和46581名男性），这些个体在检查时无冠心病。在中位随访9.2年期间，2484人发生心肌梗死，3570人发生冠心病。为了了解不健康生活方式导致的残余胆固醇升高对心肌梗死和冠心病风险的解释风险，我们进行了中介分析。
研究结果
当前吸烟、低体力活动以及低饮食指南依从性均与较高的残余胆固醇水平相关。对于当前吸烟，残余胆固醇解释了心肌梗死额外风险的15%（95%置信区间：9.7%-20%）和冠心病额外风险的16%（11%-21%）。低体力活动的相应数值分别为20%（13%-27%）和21%（15%-28%），低饮食指南依从性的相应数值分别为12%（6.6%-至18%）和14%（8.0%-19%）。在分别对男性和女性进行的分析以及在对每个生活方式因素另外调整其他三个生活方式因素的分析中，结果相似。
解读
残余胆固醇升高解释了不健康生活方式个体中部分额外的心肌梗死和冠心病风险。临床上，这些新发现强调了残余胆固醇升高以及促进健康生活方式在心肌梗死和冠心病一级预防中的重要性。
资金来源
丹麦独立研究基金；约翰·博泽鲁普和莉丝·博泽鲁普基金；医学研究理事会。
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