青年期血脂变化与中年期冠状动脉钙化发病风险：CARDIA 研究的启示。

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2024-09-13 DOI:10.1161/circimaging.123.016842

Jing-Wei Gao,Qing-Yun Hao,Ying Lin,Ze-Hua Li,Ze-Gui Huang,Zhi-Qiang Bai,Hai-Feng Zhang,Yu-Biao Wu,Zhuo-Chao Xiong,Si You,Jing-Feng Wang,Shao-Ling Zhang,Pin-Ming Liu

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引用次数: 0

摘要

背景血脂曲线的个体差异被认为是心血管事件的潜在预测因素。方法纳入了 CARDIA 研究（年轻人冠状动脉风险发展）中 2395 名初始 CAC =0 的参与者（41.6% 为男性；平均年龄（±SD）为 40.2±3.6 岁）。对血脂进行连续测量，以计算总胆固醇、低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）和甘油三酯的平均水平和变异性。结果在平均 9.0 年的随访期间，有 534 人（22.3%）出现 CAC 发病。总胆固醇、低密度脂蛋白胆固醇和非低密度脂蛋白胆固醇的平均水平越高，未来发生 CAC 的风险越大。同样，根据独立于平均值的变异性评估，血脂变异性每增加 1 个标准差，CAC 发病率的风险就会增加（低密度脂蛋白胆固醇：危险比为 1.139 [95% CI，1.048-1.238]；P=0.002；非高密度脂蛋白胆固醇：危险比为 1.102 [95% CI，1.014-1.198]；P=0.022；甘油三酯：危险比为 1.480 [95% CI，1.384-1.582]；P<0.001）。综合分析表明，血脂水平高且血脂组合（低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇）变异性高的参与者面临的 CAC 发生风险最大。具体来说，即使低密度脂蛋白胆固醇的平均水平较低，低密度脂蛋白胆固醇变异性的升高也与 CAC 发病率的额外风险相关（危险比为 1.396 [95% CI, 1.106-1.763]；P=0.005）。结论青年期低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇的变异性升高与中年CAC发病风险增加有关，尤其是在致动脉粥样硬化脂蛋白平均水平较高的人群中。这些发现强调了在整个成年早期保持持续低水平致动脉粥样硬化脂质对减少中年亚临床动脉粥样硬化的重要性。REGISTRATIONURL: https://www.clinicaltrials.gov; Unique identifier：NCT00005130。

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Variability in Lipid Profiles During Young Adulthood and the Risk of Coronary Artery Calcium Incidence in Midlife: Insights From the CARDIA Study.

BACKGROUND Intraindividual variability in lipid profiles is recognized as a potential predictor of cardiovascular events. However, the influence of early adulthood lipid profile variability along with mean lipid levels on future coronary artery calcium (CAC) incidence remains unclear. METHODS A total of 2395 participants (41.6% men; mean±SD age, 40.2±3.6 years) with initial CAC =0 from the CARDIA study (Coronary Artery Risk Development in Young Adults) were included. Serial lipid measurements were obtained to calculate mean levels and variability of total cholesterol, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides. CAC incidence was defined as CAC >0 at follow-up. RESULTS During a mean follow-up of 9.0 years, 534 individuals (22.3%) exhibited CAC incidence. Higher mean levels of total cholesterol, LDL-C, and non-HDL-C were associated with a greater risk of future CAC incidence. Similarly, 1-SD increment of lipid variability, as assessed by variability independent of the mean, was associated with an increased risk of CAC incidence (LDL-C: hazard ratio, 1.139 [95% CI, 1.048-1.238]; P=0.002; non-HDL-C: hazard ratio, 1.102 [95% CI, 1.014-1.198]; P=0.022; and triglycerides: hazard ratio, 1.480 [95% CI, 1.384-1.582]; P<0.001). Combination analyses demonstrated that participants with both high lipid levels and high variability in lipid profiles (LDL-C and non-HDL-C) faced the greatest risk of CAC incidence. Specifically, elevated variability of LDL-C was associated with an additional risk of CAC incidence even in low mean levels of LDL-C (hazard ratio, 1.396 [95% CI, 1.106-1.763]; P=0.005). These findings remained robust across a series of sensitivity and subgroup analyses. CONCLUSIONS Elevated variability in LDL-C and non-HDL-C during young adulthood was associated with an increased risk of CAC incidence in midlife, especially among those with high mean levels of atherogenic lipoproteins. These findings highlight the importance of maintaining consistently low levels of atherogenic lipids throughout early adulthood to reduce subclinical atherosclerosis in midlife. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.