国家神经系统疾病临床医学研究中心数据管理与共享系统
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
基本信息
- 负责人：戴丽叶
- 数据来源： Kailuan Study
- 论文编号：KAILUAN STUDY20190018
- 发表时间：2021-04-07
2021-04-07
已发表文章
主要研究背景及目的
Maintaining optimal lipid levels is an important component of ideal cardiovascular health. Cumulative effect of lipid carrying lipoproteins on the risk of cardiovascular disease was described by JACC Health Promotion Series, measured in either mg-years (age*LDL-C measured in mg/dl) or mmol-years (age* LDL-C measured in mmol/l). A person’s total atherosclerotic plaque burden is approximately proportional to his or her cumulative exposure to LDL. This suggests that we should not only focus on the absolute value of risk factors at a certain timing, but also pay attention to the cumulative effect of these risk factors with the extension of time. Additionally, it is unknown whether cumulative effect of lipid profile, including TG and HDL, is a determinant of residual risk in the setting of low low-density lipoprotein cholesterol. We aim to explore whether the burden of lipid profile, can predict the occurrence of vascular events and the predictive value may help to promote the primary prevention.
方法
Total TG burden = TG burden2006-2008 + TG burden2008-2010 ...+ TG burden2016-2018. Total LDL or total HDL burden were measured in the same way. Cumulative vascular events will be estimated by kaplan-meier analysis. Cox hazard model will be applied for the analysis and comparison of HR of composite events between the groups. Model 1, 2 and 3 will be adjusted for risk factors progressively, and Model 4, 5 and 6 will be applied for sensitivity analysis.
结论
We observed the correlation between cumulative burden of lipid profiles, except for cumulative burden of HDL-C,with the risk of incident IS. Cumulative burden of TC, TG and non-HDL-C may still predict IS in patients with low cumulative LDL-C burden.
主要结果
During 4.67 years (±0.70 years) follow-up on average, we identified 1023 (2.33%) incident IS. Compared with respective reference groups, the HRs (95% CIs) of the upper tertile in cumulative TG burden, cumulative LDL-C burden, cumulative TC burden and cumulative non-HDL-C burden were 1.26 mmol/L (1.02–1.55 mmol/L), 1.47 mmol/L (1.25–1.73 mmol/L), 1.33 mmol/L (1.12–1.57 mmol/L) and 1.51 mmol/L (1.28–1.80 mmol/L) for incidence of IS, respectively. However, this association was not significant in cumulative HDL-C burden and IS (HR: 1.09; 95% CI: 0.79 to 1.52), after adjustment for confounding variables. Among 16 600 participants with low cumulative LDL-C burden, HRs (95% CI) for TC, TG, non-HDL- C and HDL-C with IS were 1.63 mmol/L (1.03–2.57 mmol/L), 1.65 mmol/L (1.19–2.31 mmol/L), 1.57 mmol/L (1.06–2.32 mmol/L) and 0.98 mmol/L (0.56–1.72 mmol/L),respectively.