45~64岁高血压患者不同血压控制状态下LDL-C水平与颈动脉斑块的相关性分析  

Correlation of LDL-C levels and carotid artery plaque in patients with hypertension aged 45-64 years at different blood pressure levels

作　　者：张冬花[1] 康立惠[1] 陶娟[1] 冯杰 元鲁兵 高云[1] 李昭[1] 林运[1] Zhang Donghua;Kang Lihui;Tao Juan;Feng Jie;Yuan Lubing;Gao Yun;Li Zhao;Lin Yun(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京1100029 [2]山西省长治市潞城区人民医院心内科,长治047500 [3]山西省晋城市阳城县人民医院心内科,晋城048100

出　　处：《中国循证心血管医学杂志》2024年第12期1467-1470,1474,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：首都卫生发展科研专项(首发2022-2G-1055)。

摘　　要：目的分析45~64岁门诊就诊高血压患者不同血压控制水平下低密度脂蛋白胆固醇(LDL-C)水平与颈动脉斑块的相关性。方法本研究为横断面研究,选择2023年1月至2024年1月于首都医科大学附属北京安贞医院心内科门诊连续纳入45~64岁高血压患者。收集研究对象的基本信息、动脉粥样硬化性心血管疾病传统危险因素以及颈动脉超声检查等信息。结果本研究共纳入研究对象2521例,平均年龄为55.0±5.4岁,男性796例(31.6%)。1352例(53.6%)血压控制达标,1124例(44.6%)检出颈动脉斑块。调整性别、年龄、高血压病程、吸烟、体质指数(BMI)、糖尿病史的影响,以LDL-C≥3.4 mmol/L为参考层。在血压控制达标的高血压患者中,与参考层相比,LDL-C(2.6~3.39 mmol/L)颈动脉斑块风险没有显著降低OR=1.06(95%CI:0.81~1.39),LDL-C降至<2.6 mmol/L颈动脉斑块风险显著降低,OR=0.61(95%CI:0.45~0.82);但在血压控制未达标的高血压患者中,与参考层相比,LDL-C降至3.4 mmol/L以下颈动脉斑块的风险可显著降低,相对风险分别为0.72(95%CI:0.54~0.95),0.54(95%CI:0.40~0.74)。21.5%(542/2521)应用他汀,以LDL-C<2.6 mmol/L为达标标准,伴有颈动脉斑块、糖尿病以及ASCVD中/高危患者LDL-C达标率分别为23.8%、30.6%和18.0%。结论在血压控制达标的高血压患者中,LDL-C<2.6mmol/L与颈动脉斑块风险降低有关,而在血压控制未达标的患者中,LDL-C降至3.4 mmol/L以下与颈动脉斑块风险降低有关。他汀作为ASCVD一级预防应用不足,伴有颈动脉斑块者及ASCVD中/高危患者LDL-C达到控制目标的比例处于低水平。Objective To analyze the correlation between low density lipoprotein cholesterol(LDL-C)and carotid plaque in patients with hypertension aged 45-64 at different blood pressure levels.Methods In this cross-sectional study,2521 subjects with hypertension were enrolled in Cardiology clinics from January 2023 to January 2024.General information,traditional risk factors for atherosclerotic cardiovascular disease,and carotid ultrasound were collected.Results In the total of patients,the mean age was 55.0±5.4 years,with men were account for 31.6%.A total of 1352 subjects(53.6%)achieved BP control,1124 subjects(44.6%)had carotid plaque.There was a positive association between LDL-C levels and the prevalence of carotid plaque.Using LDL-C≥3.4 mmol/L as reference level,and after adjusting for sex,age,duration of hypertension,smoking,BMI and diabetes history,it was found that LDL-C ranging from 2.6 to 3.39 mmol/L did not significantly reduce the risk of carotid plaque(OR=1.06,95%CI:0.81~1.39).Conversely,LDL-C<2.6 mmol/L significantly reduced the risk of carotid plaque(OR=0.61,95%CI:0.45~0.82)in patients with hypertension who achieve BP control.Furthermore,LDL-C<3.4 mmol/L significantly reduced the risk of carotid plaque,with a relative risk of 0.72(95%CI:0.54~0.95)for LDL-C ranging from 2.6 to 3.39 mmol/L and 0.54(95%CI:0.40~0.74)for LDL-C<2.6 mmol/L in patients with hypertension who did not achieve BP control.Among the patients,542 subjects(21.5%)were treated with statins.The percentage of patients with the LDL-C level below 2.6mmol/L was 23.8%,30.6%and 18.0%for those with carotid plaque,diabetes mellitus or at moderate and high risk of atherosclerotic cardiovascular disease(ASCVD),respectively.Conclusions In patients with hypertension who achieved BP control,a LDL-C level<2.6 mmol/L was associated with a lower risk of carotid plaque,while in patients who did not achieve BP control,a LDL-C level under 3.4 mmol/L correlated with a decreased risk of carotid plaque.Statin use and LDL-C control proved insufficient as the prim

关 键 词：高血压 低密度脂蛋白胆固醇 颈动脉斑块 危险因素 

分 类 号：R544.1[医药卫生—心血管疾病]