Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study
Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study
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DOI：
10.1093/eurheartj/ehab432
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发表时间：
2021-07-19
影响因子：
39.3
通讯作者：
Elshazly, Mohamed Badreldin
中科院分区：
文献类型：
--
作者：
Quispe, Renato;Martin, Seth Shay;Elshazly, Mohamed Badreldin
新的证据表明，残余胆固醇（RC）促进动脉粥样硬化性心血管疾病（ASCVD）。我们的目的是评估不存在已知ASCVD的患者中低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B（apoB）以外的RC相关风险。方法和结果我们汇总了来自社区动脉粥样硬化风险研究的17532名无ASCVD个体的数据（n = 9748）、动脉粥样硬化的多种族研究（n = 3049）和年轻成人冠状动脉风险发展（n = 4735）。RC计算为非高密度脂蛋白胆固醇（非HDL-C）减去LDL-C计算值。使用校正的考克斯模型估计与log RC水平相关的ASCVD事件风险。我们还进行了不一致性分析，使用百分位数单位（>10个单位）和临床相关LDL-C目标的差异检查RC与LDL-C不一致/一致组的相对ASCVD风险。参与者的平均年龄为52.3 ± 17.9岁，56.7%为女性，34%为黑人。在中位随访18.7年期间，发生了2143起ASCVD事件。多变量校正（包括LDL-C和apoB）后，log RC与较高的ASCVD风险相关[风险比（HR）1.65，95%置信区间（CI）1.45-1.89]。此外，与一致性组相比，不一致的高RC/低LDL-C组（而非低RC/高LDL-C组）与ASCVD风险增加相关（HR 1.21，95% CI 1.08-1.34）。结论：在无ASCVD的个体中，RC水平升高与ASCVD相关，与传统的危险因素、LDL-C和apoB水平无关。RC与ASCVD相关的机制，令人惊讶地超出了apoB，以及靶向RC降低在一级预防中的潜在价值需要进一步研究。
Aims Emerging evidence suggests that remnant cholesterol (RC) promotes atherosclerotic cardiovascular disease (ASCVD). We aimed to estimate RC-related risk beyond low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B (apoB) in patients without known ASCVDMethods and results We pooled data from 17 532 ASCVD-free individuals from the Atherosclerosis Risk in Communities study (n = 9748), the Multi-Ethnic Study of Atherosclerosis (n = 3049), and the Coronary Artery Risk Development in Young Adults (n = 4735). RC was calculated as non-high-density lipoprotein cholesterol (non-HDL-C) minus calculated LDL-C. Adjusted Cox models were used to estimate the risk for incident ASCVD associated with log RC levels. We also performed discordance analyses examining relative ASCVD risk in RC vs. LDL-C discordant/concordant groups using difference in percentile units (>10 units) and clinically relevant LDL-C targets. The mean age of participants was 52.3 +/- 17.9 years, 56.7% were women and 34% black. There were 2143 ASCVD events over the median follow-up of 18.7 years. After multivariable adjustment including LDL-C and apoB, log RC was associated with higher ASCVD risk [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.45-1.89]. Moreover, the discordant high RC/low LDL-C group, but not the low RC/high LDL-C group, was associated with increased ASCVD risk compared to the concordant group (HR 1.21, 95% CI 1.08-1.34). Similar results were shown when examining discordance across clinical cutpointsConclusions In ASCVD-free individuals, elevated RC levels were associated with ASCVD independent of traditional risk factors, LDL-C, and apoB levels. The mechanisms of RC association with ASCVD, surprisingly beyond apoB, and the potential value of targeted RC-lowering in primary prevention need to be further investigated.