游离脂肪酸水平与高血压冠心病患者不良预后之间的 U 型关系：一项大型前瞻性队列研究提供的证据

IF 3.9 2区医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY

Lipids in Health and Disease Pub Date : 2024-09-10 DOI:10.1186/s12944-024-02273-z

Ting-Ting Wu, Ying Pan, Ying-Ying Zheng, Zhi-Long Wang, Chang-Jiang Deng, Shun Wang, Xiang Xie

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引用次数: 0

摘要

关于游离脂肪酸（FFA）水平对高血压冠状动脉疾病（CAD）患者预后影响的证据很少。本研究于2016年12月至2021年10月在新疆医科大学附属第一医院开展了一项平均随访2年的大型前瞻性队列研究。根据FFA浓度和高血压状态将10395名CAD患者分为不同组别，然后评估不同组别的主要结局死亡率和次要结局缺血事件。随访期间共记录了222例全因死亡率（ACM）、164例心脏死亡率（CM）、718例主要不良心血管事件（MACE）和803例主要不良心脑血管事件（MACCE）。仅在患有高血压的 CAD 患者中观察到 FFA 与不良预后之间的非线性关系。也就是说，在患有高血压的心血管疾病患者中，发现 FFA 水平与长期预后之间存在 "U 形 "关系。基线时较低的 FFA 水平（< 310 µmol/L）或较高的 FFA 水平（≥ 580 µmol/L）是导致不良后果的独立风险因素。对混杂因素进行调整后，过量的 FFA 会增加死亡率（ACM，HR = 1.957，95%CI(1.240-3.087)，P = 0.004；CM，HR = 2.704，95%CI(1.495-4.890)，P = 0.004）。890，P = 0.001）和 MACE（HR = 1.411，95%CI(1.077-1.848)，P = 0.012）、MACCE（HR = 1.299，95%CI(1.013-1.666)，P = 0.040）患病率。基线FFA水平低也会增加MACE（HR = 1.567，95%CI (1.187-2.069)，P = 0.002）和MACCE（HR = 1.387，95%CI (1.070-1.798)，P = 0.013）的发生率。FFA基线浓度与长期死亡率和缺血事件明显相关，可作为预测高血压合并CAD患者预后的更好的新型风险生物标志物。该设计的详细信息已在 https://www.chictr.org.cn/（标识符 NCT05174143）上注册。关于这一主题的已知信息有哪些？- 游离脂肪酸（FFA）在肝脏甘油三酯合成中起着至关重要的作用。多项研究表明，血浆中游离脂肪酸的浓度是代谢性疾病的一个可改变的风险因素。然而，目前还没有证据表明 FFA 与患有高血压的 CAD 患者的预后之间存在联系。这篇论文补充了什么？- 我们观察到 FFA 与 CAD 高血压患者的不良预后之间存在 "U 形 "关系，这填补了 CAD 高血压患者风险分类方面的知识空白。

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The U -shape relationship between free fatty acid level and adverse outcomes in coronary artery disease patients with hypertension: evidence from a large prospective cohort study

Evidence is scarce on the effect of free fatty acid (FFA) level in the prognosis of coronary artery disease (CAD) patients with hypertension. This study. A large prospective cohort study with a follow-up period of average 2 years was conducted at Xinjiang Medical University Affiliated First Hospital from December 2016 to October 2021. A total of 10,395 CAD participants were divided into groups based on FFA concentration and hypertension status, and then primary outcome mortality and secondary endpoint ischemic events were assessed in the different groups. A total of 222 all-cause mortality (ACMs), 164 cardiac mortality (CMs), 718 major adverse cardiovascular events (MACEs) and 803 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during follow-up period. A nonlinear relationship between FFA and adverse outcomes was observed only in CAD patients with hypertension. Namely, a “U -shape” relationship between FFA levels and long-term outcomes was found in CAD patients with hypertension. Lower FFA level (< 310 µmol/L), or higher FFA level (≥ 580 µmol/L) at baseline is independent risk factors for adverse outcomes. After adjustment for confounders, excess FFA increases mortality (ACM, HR = 1.957, 95%CI(1.240–3.087), P = 0.004; CM, HR = 2.704, 95%CI(1.495–4.890, P = 0.001) and MACE (HR = 1.411, 95%CI(1.077–1.848), P = 0.012), MACCE (HR = 1.299, 95%CI (1.013–1.666), P = 0.040) prevalence. Low levels of FFA at baseline can also increase the incidence of MACE (HR = 1.567,95%CI (1.187–2.069), P = 0.002) and MACCE (HR = 1.387, 95%CI (1.070–1.798), P = 0.013). Baseline FFA concentrations significantly associated with long-term mortality and ischemic events could be a better and novel risk biomarker for prognosis prediction in CAD patients with hypertension. The details of the design were registered on https://www.chictr.org.cn/ (Identifier NCT05174143). What is known on this topic? • Free fatty acid (FFA) plays an essential role in hepatic triglyceride synthesis . Several studies have shown that plasma FFA concentration is a modifiable risk factor for metabolic disease. However, no evidence is currently available regarding the link between FFA and prognosis in CAD patients with hypertension. What does this paper add? • We observed a “U -shape” relationship between FFA and adverse outcomes in CAD patients with hypertension, which address a novel knowledge gap in the risk classification of CAD patients with hypertension.

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来源期刊

Lipids in Health and Disease 生物-生化与分子生物学

CiteScore

7.70

自引率

2.20%

发文量

122

审稿时长

3-8 weeks

期刊介绍： Lipids in Health and Disease is an open access, peer-reviewed, journal that publishes articles on all aspects of lipids: their biochemistry, pharmacology, toxicology, role in health and disease, and the synthesis of new lipid compounds. Lipids in Health and Disease is aimed at all scientists, health professionals and physicians interested in the area of lipids. Lipids are defined here in their broadest sense, to include: cholesterol, essential fatty acids, saturated fatty acids, phospholipids, inositol lipids, second messenger lipids, enzymes and synthetic machinery that is involved in the metabolism of various lipids in the cells and tissues, and also various aspects of lipid transport, etc. In addition, the journal also publishes research that investigates and defines the role of lipids in various physiological processes, pathology and disease. In particular, the journal aims to bridge the gap between the bench and the clinic by publishing articles that are particularly relevant to human diseases and the role of lipids in the management of various diseases.