High Remnant Lipoprotein Predicts Recurrent Cardiovascular Events on Statin Treatment After Acute Coronary Syndrome
High Remnant Lipoprotein Predicts Recurrent Cardiovascular Events on Statin Treatment After Acute Coronary Syndrome
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DOI：
10.1253/circj.cj-14-0380
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发表时间：
2014-10-01
影响因子：
3.3
通讯作者：
Kugiyama, Kiyotaka
中科院分区：
文献类型：
--
作者：
Si Van Nguyen;Nakamura, Takamitsu;Kugiyama, Kiyotaka
背景：急性冠状动脉综合征（ACS）后，心血管事件复发的风险很高。富含甘油三酯的脂蛋白影响服用他汀类药物患者的心血管残余风险。本研究探讨了残余脂蛋白水平的预测价值与他汀类药物治疗后ACS.Methods和结果：共190例患者接受他汀类药物治疗后ACS继发性心血管事件。使用免疫分离法测定残余脂蛋白（残余样脂蛋白颗粒胆固醇; RLP-C）的血清水平。对所有患者进行前瞻性随访，最长随访时间为70个月或直至发生以下事件之一：心源性死亡、非致死性心肌梗死、需要计划外冠状动脉血运重建的不稳定型心绞痛或缺血性卒中。在随访期间，42例患者发生了继发性事件。多变量考克斯分析显示，高水平的RLP-C（>= 5.4 mg/dl;根据受试者工作特征曲线分析确定）是继发性事件的显著危险因素，独立于传统危险因素（风险比，2.94; 95%置信区间：1.40-6.18; P < 0.01）。将高RLP-C添加到传统危险因素中可增强净重新分类改善（NRI）和综合辨别改善（IDI）（NRI，0.66，P = 0.0003; IDI，0.08，P = 0.0002）。结论：RLP-C可用于ACS后接受他汀类药物治疗的患者继发性心血管事件的风险评估。
Background: After acute coronary syndrome (ACS), there is a high risk of recurrent cardiovascular events. Triglyceride-rich lipoproteins influence residual cardiovascular risk in patients taking statin. This study examined the predictive value of remnant lipoprotein level for secondary cardiovascular events in patients treated with statins after ACS.Methods and Results: A total of 190 patients treated with statins after ACS were enrolled in the study. The serum level of remnant lipoproteins (remnant-like lipoprotein particle cholesterol; RLP-C) was measured using an immunoseparation method. All the patients were followed prospectively for a maximum period of 70 months or until the occurrence of one of the following events: cardiac death, non-fatal myocardial infarction, unstable angina requiring unplanned coronary revascularization, or ischemic stroke. During the follow-up period, 42 patients had a secondary event. Multivariate Cox analysis showed that a high level of RLP-C (>= 5.4 mg/dl; determined on receiver operating characteristic curve analysis) was a significant risk factor for secondary events, independent of conventional risk factors (hazard ratio, 2.94; 95% confidence interval: 1.40-6.18; P < 0.01). The addition of high RLP-C to traditional risk factors enhanced net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.66, P = 0.0003; and IDI, 0.08, P = 0.0002).Conclusions: RLP-C is useful for risk assessment of secondary cardiovascular events in patients treated with statins after ACS.