Kumar Manish, Zhao Shangshu, Robinson Peter, Kuchel George A, Fortinsky Richard H, Orkaby Ariela R, Alexander Karen P, Thompson Paul D, Batsis John A, Kuo Chia-Ling
Division of Cardiovascular Medicine, Marshfield Clinic, Marshfield, Wisconsin, USA.
Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
J Am Geriatr Soc. 2025 Jun 29. doi: 10.1111/jgs.19607.
Low-density lipoprotein cholesterol (LDL-C) is associated with atherosclerotic cardiovascular disease (ASCVD), but this association diminishes with age. The triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio, also known as the atherogenic index, is a surrogate marker for small-density low-density lipoprotein cholesterol (sdLDL-C), a more specific LDL-C biomarker associated with ASCVD. It is unclear if age influences the association between the atherogenic index and incident ASCVD. We aimed to assess the influence of advancing age and an elevated atherogenic index on the risk of ASCVD.
We included UK Biobank participants without self-reported, pre-existing ASCVD and with available lipid biomarkers. We then estimated the effect of age on the associations between TG: HDL-C quintiles and incident ASCVD using a nonlinear Cox regression model.
Data from 342,979 participants were analyzed. The mean age was 56 ± 8 years (55% females), and the mean duration of follow-up was 12.7 ± 2.8 years. Individuals who developed clinical ASCVD were older (mean age at baseline 60 vs. 56 years, p < 0.001) and had a higher mean TG to HDL-C ratio (3.72 vs. 3.03, p < 0.001). Higher quintiles of the TG/HDL-C ratio (Q2-Q5) were associated with an increased risk of ASCVD compared to the first quintile (Q1) across all age groups up to 65 years. However, there was a declining risk with advancing age, as indicated by the HR for Q5 versus Q1 at ages 45, 55, and 65, which were 1.60, 1.37, and 1.07, respectively.
The association between the TG/HDL-C ratio (atherogenic index) and incident ASCVD steadily attenuates with age. In adults over 65, an elevated ratio may be associated with a lower risk of incident ASCVD. These findings may reflect changes in metabolic atherosclerotic risk or a survival effect associated with aging and require further investigation.
低密度脂蛋白胆固醇(LDL-C)与动脉粥样硬化性心血管疾病(ASCVD)相关,但这种关联会随着年龄增长而减弱。甘油三酯(TG)与高密度脂蛋白胆固醇(HDL-C)的比值,也称为致动脉粥样硬化指数,是小密度低密度脂蛋白胆固醇(sdLDL-C)的替代标志物,sdLDL-C是一种与ASCVD相关的更具特异性的LDL-C生物标志物。目前尚不清楚年龄是否会影响致动脉粥样硬化指数与ASCVD发病之间的关联。我们旨在评估年龄增长和致动脉粥样硬化指数升高对ASCVD风险的影响。
我们纳入了英国生物银行中没有自我报告的既往ASCVD且有可用血脂生物标志物的参与者。然后,我们使用非线性Cox回归模型估计年龄对TG:HDL-C五分位数与ASCVD发病之间关联的影响。
分析了342,979名参与者的数据。平均年龄为56±8岁(55%为女性),平均随访时间为12.7±2.8年。发生临床ASCVD的个体年龄更大(基线时平均年龄为60岁对56岁,p<0.001),且平均TG与HDL-C比值更高(3.72对3.03,p<0.001)。在65岁及以下的所有年龄组中,与第一五分位数(Q1)相比,TG/HDL-C比值的较高五分位数(Q2-Q5)与ASCVD风险增加相关。然而,随着年龄的增长风险逐渐降低,45岁、55岁和65岁时Q5与Q1的风险比(HR)分别为1.60、1.37和1.07,表明了这一点。
TG/HDL-C比值(致动脉粥样硬化指数)与ASCVD发病之间的关联会随着年龄的增长而稳步减弱。在65岁以上的成年人中,该比值升高可能与较低的ASCVD发病风险相关。这些发现可能反映了代谢性动脉粥样硬化风险的变化或与衰老相关的生存效应,需要进一步研究。