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心房颤动患者的低密度脂蛋白胆固醇水平与院内出血:CCC-AF项目的研究结果

Low-density lipoprotein cholesterol levels and in-hospital bleeding in patients with atrial fibrillation: findings from CCC-AF project.

作者信息

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

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Department of Geriatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, China.

出版信息

Front Cardiovasc Med. 2025 Jun 12;12:1574796. doi: 10.3389/fcvm.2025.1574796. eCollection 2025.


DOI:10.3389/fcvm.2025.1574796
PMID:40574812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12199265/
Abstract

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].

摘要

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]。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/e4056c6aa337/fcvm-12-1574796-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/4bf7a554dc6c/fcvm-12-1574796-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/9557134db4bd/fcvm-12-1574796-g002.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/e4056c6aa337/fcvm-12-1574796-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/4bf7a554dc6c/fcvm-12-1574796-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/9557134db4bd/fcvm-12-1574796-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/53c19f24f580/fcvm-12-1574796-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d877/12199265/e4056c6aa337/fcvm-12-1574796-g004.jpg

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本文引用的文献

[1]
Chinese guidelines for the diagnosis and management of atrial fibrillation.

Pacing Clin Electrophysiol. 2024-6

[2]
Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives.

Int J Environ Res Public Health. 2023-9-6

[3]
Low-density lipoprotein cholesterol, statin therapy, and cerebral microbleeds: The CIRCLE study.

Neuroimage Clin. 2023

[4]
How Low Is Too Low? A Retrospective Analysis of Very Low LDL-C Levels in Veterans.

Fed Pract. 2022-11

[5]
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Nat Rev Cardiol. 2023-6

[6]
Bleeding and thrombotic events in atrial fibrillation patients with cancer: a systematic review and meta-analysis.

Intern Emerg Med. 2023-3

[7]
Influence of hemoglobin concentration on the in-hospital outcomes in newly diagnosed heart failure patients with atrial fibrillation: Finding from CCC-AF (improving care for cardiovascular disease in China-atrial fibrillation) project.

Medicine (Baltimore). 2022-3-4

[8]
Low serum lipid levels, use of statin and cerebral microbleeds: A systematic review and meta-analysis.

J Clin Neurosci. 2021-12

[9]
Fine-Tuning of Cholesterol Homeostasis Controls Erythroid Differentiation.

Adv Sci (Weinh). 2022-1

[10]
LDL cholesterol levels and in-hospital bleeding in patients on high-intensity antithrombotic therapy: findings from the CCC-ACS project.

Eur Heart J. 2021-8-31

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