低密度脂蛋白胆固醇/残余胆固醇协调性对老年高血压患者心血管事件的预测价值  

Predictive value of low-density lipoprotein cholesterol/remnant cholesterol coordination on cardiovascular and cerebrovascular events in elderly patients with hypertension

作　　者：屈超[1] 齐疏影[1] 李响[1] 高海[1] Qu Chao;Qi Shuying;Li Xiang;Gao Hai(Deparment of Cardiology,Emergency Coronary Artery Unit,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内急诊冠脉病房,北京100029

出　　处：《中华心血管病杂志》2023年第8期844-850,共7页Chinese Journal of Cardiology

基　　金：国家自然科学基金(81800309)。

摘　　要：目的探索血清低密度脂蛋白胆固醇(LDL-C)/残余胆固醇(RC)协调性对老年高血压患者主要不良心血管事件(MACE)的预测价值。方法本研究为前瞻性队列研究。连续选取2018年6月至2020年6月在北京安贞医院住院的老年高血压患者。依照基线LDL-C/RC的协调性分为4个组,包括低LDL-C和低RC组(LDL-C<2.6 mmol/L,且RC<0.62 mmol/L)、低LDL-C和高RC组(LDL-C<2.6 mmol/L,且RC≥0.62 mmol/L)、高LDL-C和低RC组(LDL-C≥2.6 mmol/L,且RC<0.62 mmol/L)和高LDL-C和高RC组(LDL-C≥2.6 mmol/L,且RC≥0.62 mmol/L)。随访截至2022年6月,主要研究终点为MACE,包括非致死性急性冠脉综合征(ACS)、非致死性急性心力衰竭、非致死性卒中和死亡。采用Kaplan-Meier法评估4组的MACE发生率,多因素Cox回归分析评估MACE的相关因素。结果共纳入847例老年高血压患者,其中男性453例(53.5%),年龄(72.4±8.8)岁。低LDL-C和低RC组、低LDL-C和高RC组、高LDL-C和低RC组、高LDL-C和高RC组分别有207、162、263、215例。中位随访时间37个月,发生196例(23.1%)MACE,包括77例(9.1%)ACS,56例(6.6%)急性心力衰竭,34例(4.0%)卒中,29例(3.4%)全因死亡,16例(1.9%)心血管死亡。4组间比较MACE发生率差异有统计学意义(log-rankP<0.001)。高LDL-C和高RC组的MACE发生风险最高(HR=2.237,95%CI 1.328~3.783,P=0.004),其次为低LDL-C和高RC组(HR=1.745,95%CI 1.220~2.527,P=0.003)和高LDL-C和低RC组(HR=1.393,95%CI 1.048~1.774,P=0.022)。此外,4组间的非致死性ACS发生风险差异也有统计学意义(P=0.037),而急性心力衰竭、卒中、全因死亡和心血管死亡的发生率,4组间比较差异均无统计学意义(P均>0.05)。多因素Cox回归分析结果显示,年龄(HR=1.271)、高血压病程(HR=1.339)、糖尿病(HR=1.415)、高血脂(HR=1.348)、血肌酐(HR=1.263)、N末端B型利钠肽原(HR=1.316)、LDL-C(HR=1.205)、RC(HR=1.302)、低LDL-C和高RC(HR=1.745)、高LDL-C和低RC(HR=1.393)、高LDL-C和高RC(HR=2.237)均与发生MACE独立相关。Objective To explore the predictive value of serum low-density lipoprotein cholesterol/residual cholesterol(LDL-C/RC)coordination on major adverse cardiovascular events(MACE)in elderly hypertensive patients.Methods This is a prospective cohort study.Elderly hypertensive patients hospitalized in Beijing Anzhen Hospital from June 2018 to June 2020 were prospectively enrolled.According to the coordination of baseline LDL-C/RC,patients were divided into four groups:low LDL-C and low RC(LDL-C<2.6 mmol/L,and RC<0.62 mmol/L),low LDL-C and high RC(LDL-C<2.6 mmol/L,and RC≥0.62 mmol/L),high LDL-C and low RC(LDL-C≥2.6 mmol/L,and RC<0.62 mmol/L),and high LDL-C and high RC(LDL-C≥2.6 mmol/L,and RC≥0.62 mmol/L).Patients were followed up until June 2022.The primary outcome was MACE,including non-fatal acute coronary syndrome,non-fatal acute heart failure,non-fatal stroke and death.Kaplan-Meier survival analysis was used to evaluate MACE among the four groups,and Cox regression analysis was performed to evaluate the related factors of MACE.Results A total of 847 hypertensive patients were enrolled.There were 453 males(53.5%),mean age was(72.4±8.8)years.There were 207,162,263,215 patients in the low LDL-C and low RC,low LDL-C and high RC,high LDL-C and low RC and high LDL-C and high RC group,respectively.During a median follow-up of 37 months,196 patients(23.1%)had MACE,including 77 cases(9.1%)of ACS,56 cases(6.6%)of acute heart failure,34 cases(4.0%)of non-fatal stroke,29 cases(3.4%)of all-cause mortality,and 16 cases(1.9%)of cardiovascular death.Risk of MACE of the four groups was significantly different(log-rank P<0.001).Compared with low LDL-C and low RC groups,high LDL-C and high RC groups had the highest incidence of MACE(HR=2.237,95%CI 1.328-3.783,P=0.004),followed by low LDL-C and high RC groups(HR=1.745,95%CI 1.220-2.527,P=0.003)and high LDL-C and low RC groups(HR=1.393,95%CI1.048-1.774,P=0.022).In addition,the risk of nonfatal ACS among the four groups was also statistically significant(P=0.037),while the risk o

关 键 词：高血压 低密度脂蛋白胆固醇/残余胆固醇 协调性 老年 心血管事件 

分 类 号：R544.1[医药卫生—心血管疾病]