摘要
目的探讨接受血运重建治疗的开滦研究队列人群非高密度脂蛋白胆固醇(non-HDL-C)水平对术后主要不良心脑血管事件(MACCE)及全因死亡的影响。方法本研究为前瞻性队列研究,观察对象来自参加2006—2020年度体检且首次接受血运重建治疗的开滦研究队列参与者。根据non-HDL-C水平,将研究对象分为3组:non-HDL-C<2.6 mmol/L组、2.6~<3.4 mmol/L组、non-HDL-C≥3.4 mmol/L组。每年进行随访,终点事件为MACCE和全因死亡。采用Cox比例风险回归模型估计不同non-HDL-C水平对MACCE及全因死亡的影响;采用部分分布风险模型分析不同non-HDL-C水平对MACCE事件亚型的影响,将死亡视为竞争事件;采用限制性立方样条回归模型探讨non-HDL-C水平与全因死亡、MACCE及其亚型之间的剂量-反应关系。结果纳入2252例观察对象,男性2019例(89.65%),年龄(62.8±8.3)岁,随访时间5.72(3.18,8.46)年,384例(17.05%)发生MACCE,157例(6.97%)发生全因死亡。与non-HDL-C≥3.4 mmol/L组相比,non-HDL-C<2.6 mmol/L组与血运重建术后MACCE事件的发生风险降低38%相关[HR=0.62(95%CI:0.48~0.80)];non-HDL-C每降低1 mmol/L与MACCE发生风险降低20%相关[HR=0.80(95%CI:0.73~0.88)];限制性立方样条结果同样表明血运重建术后non-HDL-C水平与MACCE事件呈线性正相关(总体关联P<0.001,非线性关联P=0.808)。对于全因死亡,与non-HDL-C≥3.4 mmol/L组相比,non-HDL-C<2.6 mmol/L组血运重建术后发生全因死亡的HR=0.67(95%CI:0.46~1.01);non-HDL-C每降低1 mmol/L与全因死亡风险降低15%相关(HR=0.85,95%CI:0.73~0.99)。限制性立方样条结果表明术后non-HDL-C水平与全因死亡风险之间呈线性关联(总体关联P=0.039,非线性关联P=0.174)。结论血运重建术后降低non-HDL-C水平与MACCE和全因死亡的发生风险降低显著相关。
Objective To investigate the impact of non-high-density lipoprotein cholesterol(non-HDL-C)level on major adverse cardiovascular and cerebrovascular events(MACCE)and all-cause mortality in the Kailuan Study cohort undergoing revascularization.Methods This is a prospective cohort study,with participants from the Kailuan Study cohort who participated in physical examinations from 2006 to 2020 and received revascularization therapy for the first time.According to the level of non-HDL-C,the study subjects were divided into 3 groups:<2.6 mmol/L group,2.6-<3.4 mmol/L group,and≥3.4 mmol/L group.Annual follow-up was performed,and the endpoint events were MACCE and all-cause mortality.Cox proportional regression model was implemented to estimate the impact on MACCE and all-cause mortality associated with the different non-HDL-C groups.The partial distributed risk model was used to analyze the impact of different non-HDL-C levels on MACCE event subtypes,and death was regarded as a competitive event.The restricted cubic spline regression model was used to explore the dose-response relationship between non-HDL-C level and all-cause mortality,MACCE and its subtypes.Results A total of 2252 subjects were enrolled in the study,including 2019 males(89.65%),aged(62.8±8.3)years,the follow-up time was 5.72(3.18,8.46)years.There were 384 cases(17.05%)of MACCE and 157 cases(6.97%)of all-cause mortality.Compared with patients with non-HDL-C≥3.4 mmol/L,patients with non-HDL-C<2.6 mmol/L were associated with a 38%reduced risk of MACCE after revascularization[HR=0.62(95%CI:0.48-0.80)].Every 1 mmol/L decrease in non-HDL-C was associated with a 20%reduction in the risk of MACCE[HR=0.80(95%CI:0.73-0.88)].The results of restricted cubic spline also showed that non-HDL-C levels after revascularization therapy were positively correlated with MACCE events(overall association P<0.001,non-linear association P=0.808).For all-cause mortality,compared to the non-HDL-C≥3.4 mmol/L group,the HR for all-cause mortality after revascularization in no
作者
王雪雯
刘士贺
韩旭
刘倩
陈朔华
赵秀娟
李璐
吴寿岭
吴云涛
Wang Xuewen;Liu Shihe;Han Xu;Liu Qian;Chen Shuohua;Zhao Xiujuan;Li Lu;Wu Shouling;Wu Yuntao(School of Public Health,North China University of Science and Technology,Tangshan 063210,China;Laboratory of Cardiology,Kailuan General Hospital,Tangshan 063000,China;Clinical School,North China University of Science and Technology,Tangshan 063210,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2024年第6期667-675,共9页
Chinese Journal of Cardiology
关键词
血脂异常
队列研究
非高密度脂蛋白胆固醇
心血管疾病
血运重建术
死亡
Dyslipidemia
Cohort study
Non-high-density lipoprotein cholesterol
Cardiovascular diseases
Revascularization
Death
