Xu Tianyu, Chen Chang, An De-Wei, Zhou Yuanyuan, Yu Zhongping, Wu Yuzhong, Wu Dexi, He Xin, He Jiangui, Dong Yugang, Staessen Jan A, Liu Chen, Wei Fang-Fei
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
NHC Key Laboratory of Assisted Circulation and Vascular Disease, Sun Yat-Sen University, Guangzhou, Guangdong, China.
J Nutr Metab. 2025 Jul 16;2025:8858333. doi: 10.1155/jnme/8858333. eCollection 2025.
The aim of this study was to investigate associations of cardiovascular outcomes with lipid variability across body mass index categories. We identified 6689 participants (57.1% women) enrolled in the Atherosclerosis Risk In Communities (ARICs) study who had ≥ 3 measurements of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Cox regression models were used to compute hazard ratios (HRs)-associated heart failure (HF), myocardial infarction (MI), and mortality with 1-SD increase in lipid variability captured by SD and variability independent of the mean (VIM). We also assessed whether adding lipid variability would improve the cardiovascular risk prediction beyond the conventional risk factors. Among 2130 (31.8%) obese patients, 1907 (89.5%) had obesity classes I and II and 223 (10.5%) had obesity class III. In multivariable-adjusted analyses, TC and LDL-C variabilities were significantly ( ≤ 0.047) associated with HF in overweight (HRs ranging from 1.10 to 1.17), obesity classes I and II (1.11-1.14), and obesity class III (1.21-1.39). Higher TC and LDL-C variabilities conferred higher risk of MI and mortality in obesity classes I and II ( ≤ 0.007). Adding TC-VIM and LDL-C-VIM rather than the lipid level to a conventional risk model significantly improved risk prediction of HF with net reclassification improvement amounting to 8.95% for TC-VIM (=0.006) and 8.09% for LDL-C-VIM (=0.012). Elevated TC and LDL-C variabilities were associated with the increased risk of cardiovascular outcomes, particularly in obesity. Our observations highlight the importance of lipid variability in obesity-associated dyslipidemia.
本研究的目的是调查不同体重指数类别中心血管结局与血脂变异性之间的关联。我们在社区动脉粥样硬化风险（ARICs）研究中确定了6689名参与者（57.1%为女性），他们有≥3次总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）测量值。使用Cox回归模型计算与心力衰竭（HF）、心肌梗死（MI）和死亡率相关的风险比（HRs），血脂变异性每增加1个标准差（SD）以及独立于均值的变异性（VIM）。我们还评估了添加血脂变异性是否会在传统风险因素之外改善心血管风险预测。在2130名（31.8%）肥胖患者中，1907名（89.5%）为I级和II级肥胖，223名（10.5%）为III级肥胖。在多变量调整分析中，TC和LDL-C变异性与超重（HRs范围为1.10至1.17）、I级和II级肥胖（1.11 - 1.14）以及III级肥胖（1.21 - 1.39）患者的HF显著相关（P≤0.047）。较高的TC和LDL-C变异性使I级和II级肥胖患者发生MI和死亡的风险更高（P≤0.007）。在传统风险模型中添加TC-VIM和LDL-C-VIM而非血脂水平，显著改善了HF的风险预测，TC-VIM的净重新分类改善为8.95%（P = 0.006），LDL-C-VIM为8.09%（P = 0.012）。TC和LDL-C变异性升高与心血管结局风险增加相关，尤其是在肥胖患者中。我们的观察结果突出了血脂变异性在肥胖相关血脂异常中的重要性。
