Residual Risk of Coronary Atherosclerotic Heart Disease and Severity of Coronary Atherosclerosis Assessed by ApoB and LDL-C in Participants With Statin Treatment: A Retrospective Cohort Study.
Residual Risk of Coronary Atherosclerotic Heart Disease and Severity of Coronary Atherosclerosis Assessed by ApoB and LDL-C in Participants With Statin Treatment: A Retrospective Cohort Study.
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他汀类药物治疗参与者中通过ApoB和LDL-C评估的冠状动脉粥样硬化性心脏病的剩余风险和冠状动脉粥样硬化的严重程度：一项回顾性队列研究
DOI：
10.3389/fendo.2022.865863
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发表时间：
2022
影响因子：
5.2
通讯作者：
中科院分区：
文献类型：
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作者：
在美国和欧洲的指南中，低密度脂蛋白胆固醇(LDL-C)是高胆固醇血症降脂治疗的主要靶点，而载脂蛋白B(ApoB)是次要靶点。目的是确定在评估接受他汀类药物治疗的参与者中冠状动脉粥样硬化性心脏病的残余风险和冠状动脉粥样硬化的严重程度方面，载脂蛋白B水平升高是否优于低密度脂蛋白-C。这项研究包括131名接受他汀类药物治疗的参与者。采用广义线性模型和相对风险回归模型(具有稳健误差方差的广义线性泊松模型)分析载脂蛋白B和低密度脂蛋白胆固醇水平与冠状动脉粥样硬化程度和冠状动脉粥样硬化性心脏病残留风险的关系。根据三者对载脂蛋白B和低密度脂蛋白-C进行分类，高水平的载脂蛋白B与冠状动脉粥样硬化的严重程度显著相关(P趋势=0.012)，而与低密度脂蛋白水平的升高无关(P趋势=0.585)。经多因素调整后，载脂蛋白B水平升高与冠状动脉粥样硬化性心脏病的残余风险显著相关。与低水平载脂蛋白B(≤0.66g/L)相比，中水平载脂蛋白B(0.67~0.89g/L)和高水平载脂蛋白B(≥0.90g/L)的多变量调整RR和95%CI分别为1.16(1.01，1.33)和1.31(1.08，1.60)，P趋势=0.011。在自然对数转化的载脂蛋白B中，每单位增加一个单位，冠状动脉粥样硬化性心脏病的残余风险增加45%(P趋势和t；0.05)。然而，较高的低密度脂蛋白胆固醇水平与冠状动脉粥样硬化性心脏病的残留风险并不显著相关。与低水平低密度脂蛋白胆固醇(≤1.56mmoL/L)相比，中水平低密度脂蛋白胆固醇(≥1.57~2.30mmoL/L)和高水平低密度脂蛋白胆固醇(高密度脂蛋白2.31mmoL/L)的多变量调整RR和95%CI分别为0.99(0.84，1.15)和1.10(0.86，1.42)，P趋势=0.437。在分层分析和敏感性分析中也观察到类似的结果。载脂蛋白B和低密度脂蛋白-C均未检测到显著的交互作用(均P交互作用&>0.05)。在使用他汀类药物治疗的参与者中，载脂蛋白B升高在评估冠状动脉粥样硬化性心脏病的残余风险和冠状动脉粥样硬化的严重程度方面更具优势。
Low-density lipoprotein cholesterol (LDL-C) is the primary target of lipid-lowering therapy on the management of hypercholesterolemia in the United States and European guidelines, while apolipoprotein B (apoB) is the secondary target. The objective was to determine if elevated levels of apoB is superior to LDL-C in assessing residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment. This study included 131 participants with statin treatment. The generalized linear model and relative risk regression (generalized linear Poisson model with robust error variance) were used to analyze the association of the levels of apoB and LDL-C with the severity of coronary atherosclerosis and residual risk of coronary atherosclerotic heart disease. Categorizing apoB and LDL-C based on tertiles, higher levels of apoB were significantly associated with the severity of coronary atherosclerosis (Ptrend = 0.012), whereas no such associations were found for elevated levels of LDL-C (Ptrend = 0.585). After multivariate adjustment, higher levels of apoB were significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level apoB (≤0.66 g/L), the multivariate adjusted RR and 95% CI of intermediate-level apoB (0.67–0.89 g/L) and high-level apoB (≥0.90 g/L) were 1.16 (1.01, 1.33) and 1.31 (1.08, 1.60), respectively (Ptrend = 0.011). There was a 45% increased residual risk of coronary atherosclerotic heart disease per unit increment in natural log-transformed apoB (Ptrend <0.05). However, higher levels of LDL-C were not significantly associated with residual risk of coronary atherosclerotic heart disease. When compared with low-level LDL-C (≤1.56 mmol/L), the multivariate adjusted RR and 95% CI of intermediate-level LDL-C (1.57–2.30 mmol/L) and high-level LDL-C (≥2.31 mmol/L) were 0.99 (0.84, 1.15) and 1.10 (0.86, 1.42), respectively (Ptrend = 0.437). Similar results were observed in the stratified analyses and sensitivity analyses. No significant interactions were detected for both apoB and LDL-C (all Pinteraction >0.05). Elevated apoB are superior in assessing the residual risk of coronary atherosclerotic heart disease and severity of coronary atherosclerosis in participants with statin treatment.