Tong Xue-Ying, Lin Jing, Sun Zhao-Qing, He Qian, Zhan Yu, Jiang Chen-Xi, Tang Ri-Bo, Sang Cai-Hua, Ning Man, Jia Chang-Qi, Feng Li, Wang Wei, Zhao Xin, Li Chang-Yi, Li Song-Nan, Guo Xue-Yuan, Liu Tong, Li Meng-Meng, Yang Na, Hao Yong-Chen, Liu Jun, Liu Jing, Xie Jin, Long De-Yong, Dong Jian-Zeng, Zhao Dong, Ma Chang-Sheng
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Geriatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
Front Cardiovasc Med. 2025 Jun 12;12:1574796. doi: 10.3389/fcvm.2025.1574796. eCollection 2025.
BACKGROUND AND AIMS: Emerging evidence indicates a relationship between low-density lipoprotein cholesterol (LDL-C) levels and bleeding. However, data regarding the relationship between LDL-C levels and bleeding events in patients with atrial fibrillation (AF) remain unfilled. This study is aimed to examine the relationship between LDL-C levels and the risk of in-hospital bleeding in patients with AF. METHODS AND RESULTS: In this multi-centered observational study, 25,380 patients with AF were enrolled; 14,071 (55.4%) and 11 309 (44.6%) were men and women, respectively, and the mean age was 69.51 ± 11.88 years. After adjusting for covariates, with LDL-C ≥ 70 mg/dl as the reference, LDL-C < 70 mg/dl was associated with a higher risk of any bleeding event [adjusted odds ratio [aOR]: 1.63, 95% confidence interval [CI]: 1.12-2.35; = 0.009], major bleeding events (aOR: 1.48, 95% CI: 0.99-2.20; = 0.05), and gastrointestinal bleeding events (aOR: 2.11, 95% CI: 1.27-3.50; = 0.004) in the multivariate logistic regression model. The restricted cubic spline model showed an L-shaped relationship for bleeding events, with a higher risk at lower LDL-C levels. The nonlinear relationship between LDL-C levels and the risk of bleeding persisted among the subgroups. CONCLUSIONS: This nationwide and multi-centered AF registry study found an L-shaped relationship between LDL-C levels at admission and in-hospital bleeding events, with a greater risk at lower LDL-C levels. Further studies are needed to establish LDL-C as a factor for risk stratification and management of bleeding events in patients with AF. CLINICAL TRIAL REGISTRATION: [http://www.clinicaltrials.gov], identifier [NCT02309398].
背景与目的:新出现的证据表明低密度脂蛋白胆固醇(LDL-C)水平与出血之间存在关联。然而,关于心房颤动(AF)患者LDL-C水平与出血事件之间关系的数据仍不完整。本研究旨在探讨AF患者LDL-C水平与住院期间出血风险之间的关系。 方法与结果:在这项多中心观察性研究中,纳入了25380例AF患者;男性14071例(55.4%),女性11309例(44.6%),平均年龄为69.51±11.88岁。在对协变量进行调整后,以LDL-C≥70mg/dl作为参照,在多因素logistic回归模型中,LDL-C<70mg/dl与任何出血事件的风险较高相关[调整后的优势比[aOR]:1.63,95%置信区间[CI]:1.12 - 2.35;P = 0.009],大出血事件(aOR:1.48,95%CI:0.99 - 2.20;P = 0.05),以及胃肠道出血事件(aOR:2.11,95%CI:1.27 - 3.50;P = 0.004)。受限立方样条模型显示出血事件呈L形关系,LDL-C水平较低时风险较高。LDL-C水平与出血风险之间的非线性关系在各亚组中均持续存在。 结论:这项全国性多中心AF注册研究发现,入院时LDL-C水平与住院期间出血事件之间呈L形关系,LDL-C水平较低时风险更高。需要进一步研究以确定LDL-C作为AF患者出血事件风险分层和管理的一个因素。 临床试验注册:[http://www.clinicaltrials.gov],标识符[NCT02309398]。
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