Elevated plasma remnant cholesterol associated with long-term adverse cardiovascular events in young patients with coronary artery disease
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1.Department of Cardiology, Affiliated Hospital of Jining Medical University & Shandong Provinicial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Jining, Shandong 272029, China;2.Health Management Center, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China)

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R54

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    Abstract:

    Aim To determine the relationship between remnant cholesterol (RC) and long-term cardiovascular risk in young patients with coronary artery disease (CAD). Methods 3 200 patients with CAD hospitalized from May 2013 to November 2015 were analyzed retrospectively. They were divided into three groups according to age:young group (<45 years old), middle-aged group (45~70 years old) and elderly group (≥70 years old); They are divided into high group and low group according to RC levels. The incidence of major adverse cardiovascular event (MACE) was statistically analyzed. KM method was used to evaluate the survival rate without MACE event, and Cox regression was used to evaluate the predictors of clinical endpoint. The dose-response relationship between RC and MACE risk was demonstrated using a restricted cubic spline (RCS) model. Results A total of 3 112 patients were followed up (97.25%), including 160 in young group, 2 390 in middle-aged group, and 562 in elderly group. The median follow-up time was 7.36 years. Among them, 864 cases (27.8%) experienced MACE events. KM curve showed that RC was not a predictor of long-term MACE in patients with CAD of all ages (P>0.05), nor was it a predictor of MACE in middle-aged and elderly groups (P>0.05). KM curve and Cox regression showed that RC was an independent predictor of long-term MACE in premature CAD patients, and the risk of MACE increased by 1.07 times for every 1 mmol/L increase in RC (HR=2.7,5%CI:1.35~3.17, P<0.01). Through calculation and verification, it was found that the optimal cutoff value of RC for predicting the occurrence of MACE in premature CAD patients was 0.94 mmol/L, and the risk of MACE in premature CAD patients with RC>0.94 mmol/L increased by 1.98 times (HR=2.8,5%CI:1.41~6.32, P<0.01); Conversely, the risk of MACE was reduced by 66% in premature CAD patients with RC<0.94 mmol/L (HR=0.4,5%CI:0.16~0.71, P<0.01). Conclusion RC is an independent predictor of long-term MACE occurrence in premature CAD patients (7.36 years). The optimal cutoff value of RC in this population is 0.94 mmol/L. Controlling RC below 0.94 mmol/L is able to reduce the risk of MACE by 66% in premature CAD patients.

    Reference
    [1] Authors/Task Force Members, ESC Committee for Practice Guidelines (CPG), ESC National Cardiac Societies.2019 ESC/EAS guidelines for the management of dyslipidaemias:lipid modification to reduce cardiovascular risk.Atherosclerosis, 9,0:140-205.
    [2] WONG N D, ZHAO Y L, QUEK R G W, et al.Residual atherosclerotic cardiovascular disease risk in statin-treated adults:the multi-ethnic study of atherosclerosis.J Clin Lipidol, 7,1(5):1223-1233.
    [3] LANDRAY M J, HAYNES R, HOPEWELL J C, et al.Effects of extended-release niacin with laropiprant in high-risk patients.N Engl J Med, 4,1(3):203-212.
    [4] LAWLER P R, AKINKUOLIE A O, CHU A Y, et al.Atherogenic lipoprotein determinants of cardiovascular disease and residual risk among individuals with low low-density lipoprotein cholesterol.J Am Heart Assoc, 7,6(7):e005549.
    [5] CHAIT A, GINSBERG H N, VAISAR T, et al.Remnants of the triglyceride-rich lipoproteins, diabetes, and cardiovascular disease.Diabetes, 0,9(4):508-516.
    [6] VARBO A, BENN M, TYBJRG-HANSEN A, et al.Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation.Circulation, 3,8(12):1298-1309.
    [7] JRGENSEN A B, FRIKKE-SCHMIDT R, WEST A S, et al.Genetically elevated non-fasting triglycerides and calculated remnant cholesterol as causal risk factors for myocardial infarction.Eur Heart J, 3,4(24):1826-1833.
    [8] QUISPE R, MARTIN S S, MICHOS E D, et al.Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB:a primary prevention study.Eur Heart J, 1,2(42):4324-4332.
    [9] ELSHAZLY M B, MANI P, NISSEN S, et al.Remnant cholesterol, coronary atheroma progression and clinical events in statin-treated patients with coronary artery disease.Eur J Prev Cardiol, 0,7(10):1091-1100.
    [10] GAO S D, XU H B, MA W J, et al.Remnant cholesterol predicts risk of cardiovascular events in patients with myocardial infarction with nonobstructive coronary arteries.J Am Heart Assoc, 2,1(10):e024366.
    [11] WINTER M P, WIESBAUER F, BLESSBERGER H, et al.Lipid profile and long-term outcome in premature myocardial infarction.Eur J Clin Invest, 8,8(10):e13008.
    [12] 中华医学会心血管病学分会.心血管疾病防治指南和共识-2012.北京:人民卫生出版社, 2012.Cardiovascular Branch of the Chinese Medical Association.Guidelines and consensus for the prevention and treatment of cardiovascular diseases-2012.Beijing:People's Health Publishing House, 2012.
    [13] VARBO A, BENN M, TYBJRG-HANSEN A, et al.Remnant cholesterol as a causal risk factor for ischemic heart disease.J Am Coll Cardiol, 3,1(4):427-436.
    [14] CASTAER O, PINT X, SUBIRANA I, et al.Remnant cholesterol, not LDL cholesterol, is associated with incident cardiovascular disease.J Am Coll Cardiol, 0,6(23):2712-2724.
    [15] SHAO Q Y, YANG Z Q, WANG Y F, et al.Elevated remnant cholesterol is associated with adverse cardiovascular outcomes in patients with acute coronary syndrome.J Atheroscler Thromb, 2,9(12):1808-1822.
    [16] 中华医学会心血管病学分会介入心脏病学组, 中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2012(简本).中华心血管病杂志, 2,0(4):271-277.Interventional Cardiology Group of Cardiovascular Branch of Chinese Medical Association, Editorial Committee of Chinese Journal of Cardiology.Chinese guidelines for percutaneous coronary intervention 2012 (simplified).Chin J Cardiol, 2012(4):271-277.
    [17] NEUMANN F J, SOUSA-UVA M, AHLSSON A, et al.2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J, 9,0(2):87-165.
    [18] HICKS K A, MAHAFFEY K W, MEHRAN R, et al.2017 cardiovascular and stroke endpoint definitions for clinical trials.Circulation, 8,7(9):961-972.
    [19] 魏源, 周锦辉, 张振伟, 等.限制性立方样条在Cox比例风险回归模型中的应用.中华预防医学杂志, 0,4(10):1169-1173.WEI Y, ZHOU J H, ZHANG Z W, et al.et al.Application of restricted cube spline in Cox regression model.Chin J Pre Med, 0,4(10):1169-1173.
    [20] RALLIDIS L S, XENOGIANNIS I, BRILAKIS E S, et al.Causes, angiographic characteristics, and management of premature myocardial infarction:JACC State-of-the-Art review.J Am Coll Cardiol, 2,9(24):2431-2449.
    [21] ZEITOUNI M, CLARE R M, CHISWELL K, et al.Risk factor burden and long-term prognosis of patients with premature coronary artery disease.J Am Heart Assoc, 0,9(24):e017712.
    [22] COLLET J P, ZEITOUNI M, PROCOPI N, et al.Long-term evolution of premature coronary artery disease.J Am Coll Cardiol, 9,4(15):1868-1878.
    [23] SINGH A, COLLINS B L, GUPTA A, et al.Cardiovascular risk and statin eligibility of young adults after an MI:partners young-MI registry.J Am Coll Cardiol, 8,1(3):292-302.
    [24] ARDISSINO M, NELSON A J, MAGLIETTA G, et al.Sex-related differences in long-term outcomes after early-onset myocardial infarction.Front Cardiovasc Med, 2,9:863811.
    [25] SPRING B, MOLLER A C, COLANGELO L A, et al.Healthy lifestyle change and subclinical atherosclerosis in young adults:coronary artery risk development in young adults (CARDIA) study.Circulation, 4,0(1):10-17.
    [26] GARSHICK M S, VAIDEAN G D, VANI A, et al.Cardiovascular risk factor control and lifestyle factors in young to middle-aged adults with newly diagnosed obstructive coronary artery disease.Cardiology, 9,2(2):83-90.
    [27] KEXIN W, YAODONG D, WEN G, et al.Association of increased remnant cholesterol and the risk of coronary artery disease:a retrospective study.Front Cardiovasc Med, 1,8:740596.
    [28] LANGSTED A, MADSEN C M, NORDESTGAARD B G.Contribution of remnant cholesterol to cardiovascular risk.J Intern Med, 0,8(1):116-127.
    [29] CHEN Y L, LI G X, GUO X F, et al.The effects of calculated remnant-like particle cholesterol on incident cardiovascular disease:insights from a general Chinese population.J Clin Med, 1,0(15):3388.
    [30] FU L Y, TAI S, SUN J X, et al.Remnant cholesterol and its visit-to-visit variability predict cardiovascular outcomes in patients with type 2 diabetes:findings from the ACCORD cohort.Diabetes Care, 2,5(9):2136-2143.
    [31] VALLEJO-VAZ A J, FAYYAD R, BOEKHOLDT S M, et al.Triglyceride-rich lipoprotein cholesterol and risk of cardiovascular events among patients receiving statin therapy in the TNT trial.Circulation, 8,8(8):770-781.
    [32] VARBO A, FREIBERG J J, NORDESTGAARD B G.Extreme nonfasting remnant cholesterol vs extreme LDL cholesterol as contributors to cardiovascular disease and all-cause mortality in 90 000 individuals from the general population.Clin Chem, 5,1(3):533-543.
    [33] 陈焱, 徐清, 周庆志, 等.残余胆固醇与心血管疾病风险的研究现状.中国动脉硬化杂志, 2,0(7):640-644.CHEN Y, XU Q, ZHOU Q Z, et al.et al research status of remnant cholesterol and cardiovascular disease risk.Chin J Arterioscler, 2,0(7):640-644.
    [34] CAO Y X, ZHANG H W, JIN J L, et al.The longitudinal association of remnant cholesterol with cardiovascular outcomes in patients with diabetes and pre-diabetes.Cardiovasc Diabetol, 0,9(1):104.
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ZHANG Shaohui, SU Qiang, GENG Yaming, PAN Hui, ZHANG Yang, SU Xing, ZHANG Huiling, WANG Jianjun. Elevated plasma remnant cholesterol associated with long-term adverse cardiovascular events in young patients with coronary artery disease[J]. Editorial Office of Chinese Journal of Arteriosclerosis,2023,31(12):1058-1066.

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History
  • Received:May 23,2023
  • Revised:October 04,2023
  • Online: December 29,2023
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