Jeffrey Shi Kai Chan, Danish Iltaf Satti, Raymond Ngai Chiu Chan, Parag Chevli, Adhya Mehta, Seth S Martin, Garima Sharma, Gary Tse, Salim S Virani, Michael D Shapiro
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Outcomes included the index Agatston score, cardiovascular mortality, all-cause mortality, and high-sensitivity C-reactive protein. Altogether, 1515 participants were analysed. Higher HDL-C variability was associated with higher index Agatston score [Quartile 4 (Q4; vs. Q1) adjusted marginal effects 0.25 0.02-0.48)], but not LDL-C, TC, and triglyceride variability. Over a 15.1-year median follow-up, higher HDL-C [Q4 vs. Q1: adjusted sub-hazard ratio 2.68 (1.61-4.48)] and TC [Q4 vs. Q1: adjusted sub-hazard ratio 2.13 (1.17-3.89)] variability, but not LDL-C and triglyceride variability, was associated with higher risk of cardiovascular mortality, which remained significant after adjusting for the index Agatston score. Additionally, higher HDL-C variability was associated with higher risk of all-cause mortality [Q4 vs. Q1: adjusted hazard ratio 1.46 (1.00-2.11)], but LDL-C, TC, and triglyceride variability were not. HDL-C [Q4 vs. Q1: adjusted β: 0.132 (0.034-0.230)] and TC [Q4 vs. Q1: adjusted β: 0.210 (0.064-0.357)] variability, but not LDL-C and triglyceride variability, may be correlated with high-sensitivity C-reactive protein.</p><p><strong>Conclusion: </strong>Elevated HDL-C variability was associated with greater CAC burden and long-term risks of cardiovascular and all-cause mortality. 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引用次数: 0
摘要
目的：本研究旨在探讨访间血脂变异性、冠状动脉钙化（CAC）、炎症和长期死亡率之间的关系，这可能与预后相关。方法：这项前瞻性队列研究纳入了来自动脉粥样硬化多民族研究的参与者，他们的血浆低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）和甘油三酯均来自三次初始检查，并在第三次（指数）检查时接受了计算机断层扫描CAC定量。访问到访问的变异性（变异系数）从所有三个初始检查计算。结果包括Agatston评分指数、心血管死亡率、全因死亡率和高敏c反应蛋白（hsCRP）。结果：共分析了1515名参与者。较高的HDL-C变异性与较高的Agatston评分相关(四分位数4 [Q4；与Q1]调整边际效应0.25 [0.02-0.48])，但不包括LDL-C、TC和甘油三酯可变性。在15.1年的中位随访中，较高的HDL-C （Q4 vs Q1：调整亚危险比2.68 [1.61-4.48]）和TC （Q4 vs Q1：调整亚危险比2.13 [1.17-3.89]）变异性与较高的心血管死亡风险相关，但LDL-C和甘油三酯变异性与较高的心血管死亡风险无关，在调整Agatston指数评分后，这一差异仍然显著。此外，较高的HDL-C变异性与较高的全因死亡率相关（Q4 vs Q1：校正风险比1.46 [1.00-2.11]），但LDL-C、TC和甘油三酯变异性与此无关。HDL-C （Q4 vs Q1：调整后的β: 0.132 [0.034-0.230]）和TC （Q4 vs Q1：调整后的β: 0.210 [0.064-0.357]）可变性可能与hsCRP相关，但LDL-C和甘油三酯可变性不相关。结论：升高的HDL-C变异性与更大的CAC负担以及心血管和全因死亡的长期风险相关。这些死亡率相关的关联可能不能完全用动脉粥样硬化来解释。
Visit-to-visit lipid variability, coronary artery calcification, inflammation, and mortality in the Multi-Ethnic Study of Atherosclerosis.
Aims: This study aimed to explore relationships between visit-to-visit lipid variability, coronary artery calcification (CAC), inflammation, and long-term mortality, which may be prognostically relevant.
Methods and results: This prospective cohort study included participants from the Multi-Ethnic Study of Atherosclerosis with available plasma LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), total cholesterol (TC), and triglycerides from all three initial exams who underwent computed tomography CAC quantification at the third (index) exam. Visit-to-visit variability (coefficient of variation) was calculated from all three initial exams. Outcomes included the index Agatston score, cardiovascular mortality, all-cause mortality, and high-sensitivity C-reactive protein. Altogether, 1515 participants were analysed. Higher HDL-C variability was associated with higher index Agatston score [Quartile 4 (Q4; vs. Q1) adjusted marginal effects 0.25 0.02-0.48)], but not LDL-C, TC, and triglyceride variability. Over a 15.1-year median follow-up, higher HDL-C [Q4 vs. Q1: adjusted sub-hazard ratio 2.68 (1.61-4.48)] and TC [Q4 vs. Q1: adjusted sub-hazard ratio 2.13 (1.17-3.89)] variability, but not LDL-C and triglyceride variability, was associated with higher risk of cardiovascular mortality, which remained significant after adjusting for the index Agatston score. Additionally, higher HDL-C variability was associated with higher risk of all-cause mortality [Q4 vs. Q1: adjusted hazard ratio 1.46 (1.00-2.11)], but LDL-C, TC, and triglyceride variability were not. HDL-C [Q4 vs. Q1: adjusted β: 0.132 (0.034-0.230)] and TC [Q4 vs. Q1: adjusted β: 0.210 (0.064-0.357)] variability, but not LDL-C and triglyceride variability, may be correlated with high-sensitivity C-reactive protein.
Conclusion: Elevated HDL-C variability was associated with greater CAC burden and long-term risks of cardiovascular and all-cause mortality. These mortality-related associations were probably not completely explainable by atherosclerosis.
期刊介绍：
European Journal of Preventive Cardiology (EJPC) is an official journal of the European Society of Cardiology (ESC) and the European Association of Preventive Cardiology (EAPC). The journal covers a wide range of scientific, clinical, and public health disciplines related to cardiovascular disease prevention, risk factor management, cardiovascular rehabilitation, population science and public health, and exercise physiology. The categories covered by the journal include classical risk factors and treatment, lifestyle risk factors, non-modifiable cardiovascular risk factors, cardiovascular conditions, concomitant pathological conditions, sport cardiology, diagnostic tests, care settings, epidemiology, pharmacology and pharmacotherapy, machine learning, and artificial intelligence.
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