Markus Marcello Ricardo Paulista, Ittermann Till, Mariño Coronado Joany, Schipf Sabine, Bahls Martin, Könemann Stephanie, Chamling Bishwas, Völzke Henry, Damasceno Nágila Raquel Teixeira, Santos Raul Dias, Felix Stephan Burkhard, Templin Christian, Steinhagen-Thiessen Elisabeth, Dörr Marcus
Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald 17475, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.
Eur Heart J. 2025 May 5. doi: 10.1093/eurheartj/ehaf281.
Associations of hyperlipidaemia and inflammation with the risk for incident major adverse cardiovascular events (MACEs) were analysed in individuals with and without cholesterol-lowering medication therapy.
Data from 322,922 participants (55.9% women) aged 38 to 73 years from the UK Biobank were included. Longitudinal associations of low-density lipoprotein cholesterol (LDL-C), lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (Hs-CRP), both individually and in combination, were analysed with the risk for incident MACEs using Cox regression models, stratified by cholesterol-lowering medication use.
During a median follow-up of 13.7 years, 31,295 (9.69%) participants had incident MACEs. The incidence was 8.32% in non-users and 18.6% in users of cholesterol-lowering medication. Higher LDL-C levels were associated with the highest risk for MACEs, followed by Lp(a) and Hs-CRP. One higher standard deviation in LDL-C, Lp(a), and Hs-CRP was associated with a 13%, 8%, and 6% greater risk for MACEs in non-users and 11%, 7%, and 6% in cholesterol-lowering medication users, respectively. When combined, LDL-C, Lp(a), and Hs-CRP demonstrated a synergistic effect. Compared with individuals with all three biomarkers at or below the 75th percentile, those with all three biomarkers above the 75th percentile had a 77% higher risk for incident MACEs among non-users and a 58% higher risk among those on cholesterol-lowering medications.
Hyperlipidaemia and inflammation independently and synergistically contribute to an increased risk for incident cardiovascular events. The magnitude of risk is more closely related to serum biomarker concentrations than to the use or not of cholesterol-lowering medications.
在接受和未接受降胆固醇药物治疗的个体中，分析高脂血症和炎症与发生主要不良心血管事件（MACE）风险之间的关联。
纳入来自英国生物银行的322,922名年龄在38至73岁之间的参与者（55.9%为女性）的数据。使用Cox回归模型分析低密度脂蛋白胆固醇（LDL-C）、脂蛋白(a) [Lp(a)]和高敏C反应蛋白（Hs-CRP）单独及联合时与发生MACE风险的纵向关联，并按降胆固醇药物使用情况进行分层。
在中位随访13.7年期间，31,295名（9.69%）参与者发生了MACE。未使用者的发生率为8.32%，降胆固醇药物使用者为18.6%。较高的LDL-C水平与MACE的最高风险相关，其次是Lp(a)和Hs-CRP。LDL-C、Lp(a)和Hs-CRP每升高一个标准差，未使用者发生MACE的风险分别增加13%、8%和6%，降胆固醇药物使用者分别增加11%、7%和6%。当三者联合时，LDL-C、Lp(a)和Hs-CRP表现出协同效应。与三项生物标志物均处于或低于第75百分位数的个体相比，三项生物标志物均高于第75百分位数的个体，未使用者发生MACE的风险高77%，接受降胆固醇药物治疗者高58%。
高脂血症和炎症独立且协同地导致心血管事件发生风险增加。风险程度与血清生物标志物浓度的关系比与是否使用降胆固醇药物的关系更为密切。
