Association between estimated cumulative LDL-C exposure and coronary artery disease severity and 2-year prognosis in acute coronary syndrome patients
10.3760/cma.j.cn112148-20241031-00661
- VernacularTitle:估测的LDL-C累积暴露量与ACS患者冠状动脉病变严重程度及2年预后的相关性研究
- Author:
Yichun HAO
1
;
Jing CHEN
;
Shaodi YAN
;
Ying SONG
;
Lin JIANG
;
Yan CHEN
;
Cheng CUI
;
Zhan GAO
;
Xueyan ZHAO
;
Yin ZHANG
;
Lijian GAO
;
Jue CHEN
;
Jinqing YUAN
;
Lei SONG
;
Jingjing XU
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院冠心病中心，北京 100037
- Publication Type:Journal Article
- Keywords:
Acute coronary syndrome;
Low density lipoprotein cholesterol;
Biomarkers;
Risk factors
- From:
Chinese Journal of Cardiology
2025;53(3):274-280
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the association between estimated cumulative low-density lipoprotein cholesterol (LDL-C) exposure and the severity of coronary artery disease and long-term adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS).Methods:The subjects were from the PROMISE study. This study was a prospective cohort study led by Fuwai Hospital, Chinese Academy of Medical Sciences, with participation from eight regional tertiary hospitals as sub-centers, and enrolled 18 701 patients with confirmed coronary heart disease between January 2015 and May 2019. Among them, 8 429 patients with ACS were included in this study. The estimated cumulative LDL-C exposure was calculated by multiplying LDL-C by age. Participants were then divided into four groups based on quartiles. Baseline data and coronary angiography data were collected, and participants were followed for 2 years. The primary endpoint was MACCE, which was composed of all-cause death, cardiac death, myocardial infarction, revascularization, and stroke. Spearman correlation analysis was used to estimate the correlation between cumulative LDL-C exposure and the severity of coronary artery disease. The differences in MACCE among the four groups were compared, and multivariate Cox regression was used to divide the estimated cumulative exposure LDL-C into two groups, three groups, and four groups to analyze its relationship with MACCE.Results:The 8 429 ACS patients included in the study had an age of (60.9±11.4) years, with 1 951(23.1%) females. Spearman correlation analysis revealed that estimated cumulative LDL-C exposure was positively associated with the preoperative SYNTAX score, three-vessel lesions disease, left main disease, and the number of target lesions (correlation coefficients r=0.14, 0.10, 0.04 and 0.03, respectively, with all P<0.05). The 2-year follow-up results indicated that the incidence rates of MACCE, all-cause death, cardiac death, myocardial infarction, and stroke in ACS patients grouped by different levels of estimated cumulative LDL-C exposure were statistically significant (all P<0.05). The results of the Cox multivariate regression analysis showed that when the estimated cumulative LDL-C exposure was treated as a continuous variable and analyzed in two, three, and four groups, with the lowest group as the reference, the risk of MACCE occurrence in the high-value group increased by 21% (95% CI 1.08-1.37, P=0.002), 24% (95% CI 1.07-1.43, P=0.004), and 21% (95% CI 1.02-1.43, P=0.025) respectively. Conclusions:A positive correlation was found between estimated cumulative LDL-C exposure and severity of coronary artery disease. High estimated cumulative LDL-C exposure level is a risk factor for MACCE in ACS patients within 2 years.
