残余胆固醇与动脉僵硬度轨迹的关联分析  

Association between remnant cholesterol and the trajectory of arterial stiffness progression

作　　者：王金麒 金笑寒 金瑞 武志远 韩泽 许宗锴 刘玥叡静 赵小雨 陶丽新 Wang Jinqi;Jin Xiaohan;Jin Rui;Wu Zhiyuan;Han Ze;Xu Zongkai;Liu Yueruijing;Zhao Xiaoyu;Tao Lixin(Beijing Municipal Key Laboratory of Clinical Epidemiology,Department of Epidemiology and Health Statistics,School of Public Health,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学公共卫生学院,流行病与卫生统计学系,临床流行病学北京市重点实验室,北京100069

出　　处：《中华心血管病杂志》2024年第11期1302-1310,共9页Chinese Journal of Cardiology

基　　金：国家自然科学基金(82073668,81872708)。

摘　　要：目的探讨残余胆固醇单一时点基线水平及其长期累积暴露水平对动脉僵硬度进展轨迹的影响。方法本研究为前瞻性队列研究。选取北京健康管理队列中连续参加2010—2011、2012—2013、2014—2015年健康体检的参与者,符合入选标准者共2401例。以2014—2015年的残余胆固醇值作为基线残余胆固醇暴露水平,以2010—2015年3次体检的残余胆固醇值计算其累积暴露指标,包括累积暴露量、累积暴露负担和高残余胆固醇暴露时间。通过测量臂踝脉搏波速度(baPWV)评估动脉僵硬度。随访至2019年12月31日,期间每年随访1次,应用基于组的轨迹模型构建随访期间的baPWV进展轨迹。采用有序logistic回归模型,校正传统心血管风险因素和低密度脂蛋白胆固醇(LDL-C)水平,分析残余胆固醇基线水平、残余胆固醇累积暴露指标与baPWV进展轨迹的关联。结果研究对象年龄61(54,69)岁,其中男性1801人(75.01%)。基于组的轨迹模型结果显示,将研究对象分为3个亚组时模型拟合效果最佳,3组分别为baPWV低-上升组(1036人,43.15%)、中-上升组(1137人,47.36%)和高-上升组(228人,9.50%)。校正传统的心血管危险因素后,有序logistic回归分析发现单一时点的基线残余胆固醇水平(OR=1.170,95%CI:1.074~1.274)、残余胆固醇累积暴露量(OR=1.194,95%CI:1.096~1.303)、有累积暴露负担(OR=1.270,95%CI:1.071~1.507)和高残余胆固醇暴露时间(6年:OR=1.351,95%CI:1.077~1.695)均与不良的baPWV进展轨迹发生风险显著相关,校正累积平均LDL-C水平后上述结论仍然成立。校正累积残余胆固醇水平后的基线残余胆固醇水平与baPWV进展的关联性无统计学意义(OR=1.053,95%CI:0.923~1.197),而校正基线残余胆固醇水平后,残余胆固醇累积暴露量仍与baPWV不良进展显著相关(OR=1.145,95%CI:1.008~1.305)。结论高水平的基线残余胆固醇与残余胆固醇累积暴露均是动脉僵硬度不良进展的独立危险因�Objective To explore the impact of baseline remnant cholesterol levels at a single time point and cumulative remnant cholesterol exposure on the progression trajectories of arterial stiffness.Methods This prospective cohort study included 2401 eligible participants from the Beijing Health Management Cohort who consecutively attended health examinations in 2010-2011,2012-2013,and 2014-2015.The remnant cholesterol value measured in 2014-2015 served as the baseline remnant cholesterol level at a single time point.The cumulative exposure indices were calculated based on remnant cholesterol values from three health examinations from 2010 to 2015,including cumulative exposure,cumulative exposure burden,and duration of high remnant cholesterol exposure.Arterial stiffness was assessed by brachial-ankle pulse wave velocity(baPWV).The follow-up continued until December 31,2019,with annual check-ups.During the follow-up period,a group-based trajectory model was employed to construct the progression trajectories of baPWV.The associations between the baseline remnant cholesterol level,cumulative exposure indices of remnant cholesterol and baPWV trajectories were examined using ordinal logistic regression models,adjusting for traditional cardiovascular risk factors and low-density lipoprotein cholesterol(LDL-C)levels.Results The age of the 2401 participants was 61(54,69)years,with 1801(75.01%)being male.The group-based trajectory model indicated that the best-fit model categorized the participants into three subgroups:low-rising group(1036 individuals,43.15%),moderate-rising group(1137 individuals,47.36%),and high-rising group(228 individuals,9.50%).After adjusting for traditional cardiovascular risk factors,baseline remnant cholesterol levels at a single point(OR=1.170,95%CI:1.074-1.274),cumulative remnant cholesterol exposure(OR=1.194,95%CI:1.096-1.303),cumulative remnant cholesterol exposure burden(OR=1.270,95%CI:1.071-1.507),and high-remnant cholesterol exposure duration(6 years:OR=1.351,95%CI:1.077-1.695)were significantl

关 键 词：胆固醇 残余胆固醇 累积暴露 臂踝脉搏波速度 动脉僵硬度轨迹 残余风险 

分 类 号：R543.5[医药卫生—心血管疾病]