1.Association of polychlorinated biphenyl exposure with platelet parameters across different glycemic states: The moderating role of a healthy lifestyle
Zhuo CHEN ; Huilin LOU ; Taimeng CHEN ; Fangyuan LIN ; Xueyan WU ; Yao GUO ; Haoran XU ; Mengke CHENG ; Peihan CHEN ; Yilin ZHOU ; Zhenxing MAO ; Xin TANG
Journal of Environmental and Occupational Medicine 2026;43(5):535-541
Background Platelet parameters are important indicators of cardiovascular risk, and environmental pollutants such as polychlorinated biphenyls (PCBs) may impair platelet function through oxidative stress. Objective To investigate the differential effects of single and mixed exposure to PCBs on platelet parameters among individuals with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM), and to evaluate the potential modifying role of a healthy lifestyle. Methods This study included 2249 participants (including 707 with NGT, 759 with IFG, and 783 with T2DM). Plasma PCB concentrations were measured using triple quadrupole gaschromatography-tandem mass spectrometry. Generalized linear regression was used to assess the associations between individual PCB congeners and platelet parameters. Quantile g-computation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the overall effects of PCBs mixture exposure on platelet parameters across different glycemic states, as well as its interaction with healthy lifestyle score (HLS). Results Generalized linear regression analyses showed significant differences in the effects of PCBs on platelet parameters across different glycemic states (P<0.05). After adjusting for confounders, PCBs mixture exposure was significantly associated with lower platelet counts (PLT) in individuals with NGT (b=−10.60, 95%CI: −16.48, −4.71) and IFG (b=−12.91, 95%CI: −18.90, −6.92), whereas no significant association was observed in individuals with T2DM (P=0.051). Mean platelet volume (MPV) and platelet-large cell ratio (P-LCR) increased significantly with higher PCBs exposure levels across all three groups (P<0.05). BKMR analysis showed a positive association between PCBs mixture exposure and P-LCR, with the strongest association observed in the NGT group. Furthermore, a significant interaction was observed between HLS and PCBs mixture exposure, and a higher HLS attenuated the effects of PCBs on P-LCR. Conclusion Glycemic glycemic states may modify the effects of PCBs on platelets. Individuals with NGT appear more sensitive to PCBs exposure, whereas the T2DM state may attenuate this effect. Moreover, healthy lifestyles, including not smoking, moderate alcohol consumption, maintaining moderate-to-high physical activity, a healthy diet, and an appropriate body mass index (BMI), may mitigate the adverse effects of most PCBs on platelet parameters.
2.Association of polychlorinated biphenyl exposure with platelet parameters across different glycemic states: The moderating role of a healthy lifestyle
Zhuo CHEN ; Huilin LOU ; Taimeng CHEN ; Fangyuan LIN ; Xueyan WU ; Yao GUO ; Haoran XU ; Mengke CHENG ; Peihan CHEN ; Yilin ZHOU ; Zhenxing MAO ; Xin TANG
Journal of Environmental and Occupational Medicine 2026;43(5):535-541
Background Platelet parameters are important indicators of cardiovascular risk, and environmental pollutants such as polychlorinated biphenyls (PCBs) may impair platelet function through oxidative stress. Objective To investigate the differential effects of single and mixed exposure to PCBs on platelet parameters among individuals with normal glucose tolerance (NGT), impaired fasting glucose (IFG), and type 2 diabetes mellitus (T2DM), and to evaluate the potential modifying role of a healthy lifestyle. Methods This study included 2249 participants (including 707 with NGT, 759 with IFG, and 783 with T2DM). Plasma PCB concentrations were measured using triple quadrupole gaschromatography-tandem mass spectrometry. Generalized linear regression was used to assess the associations between individual PCB congeners and platelet parameters. Quantile g-computation (QGC) and Bayesian kernel machine regression (BKMR) models were used to evaluate the overall effects of PCBs mixture exposure on platelet parameters across different glycemic states, as well as its interaction with healthy lifestyle score (HLS). Results Generalized linear regression analyses showed significant differences in the effects of PCBs on platelet parameters across different glycemic states (P<0.05). After adjusting for confounders, PCBs mixture exposure was significantly associated with lower platelet counts (PLT) in individuals with NGT (b=−10.60, 95%CI: −16.48, −4.71) and IFG (b=−12.91, 95%CI: −18.90, −6.92), whereas no significant association was observed in individuals with T2DM (P=0.051). Mean platelet volume (MPV) and platelet-large cell ratio (P-LCR) increased significantly with higher PCBs exposure levels across all three groups (P<0.05). BKMR analysis showed a positive association between PCBs mixture exposure and P-LCR, with the strongest association observed in the NGT group. Furthermore, a significant interaction was observed between HLS and PCBs mixture exposure, and a higher HLS attenuated the effects of PCBs on P-LCR. Conclusion Glycemic glycemic states may modify the effects of PCBs on platelets. Individuals with NGT appear more sensitive to PCBs exposure, whereas the T2DM state may attenuate this effect. Moreover, healthy lifestyles, including not smoking, moderate alcohol consumption, maintaining moderate-to-high physical activity, a healthy diet, and an appropriate body mass index (BMI), may mitigate the adverse effects of most PCBs on platelet parameters.
3.Role of NLRP3 inflammasome-mediated microglia activation in myocardial ischaemia-reperfusion-induced brain injury in mice
Hu CHENG ; Xiao CHENG ; Xueyan LI ; Yasen YALI ; Jianjiang WU ; Long YANG ; Wenbin YU ; Kuo ZHU ; Jiang WANG
Chinese Journal of Anesthesiology 2025;45(7):827-833
Objective:To evaluate the role of NOD-like receptor protein 3 (NLRP3) inflammasome-mediated microglia activation in myocardial ischaemia-reperfusion-induced brain injury in mice.Methods:Fifty-two SPF healthy male wild-type C57BL/6 mice and 52 NLRP3 -/- mice, aged 8-10 weeks, were divided into 4 groups ( n=26 each) using a random number table method: wild type sham operation group (W-S group), wild type myocardial ischemia-reperfusion group (W-IR group), NLRP3 -/- sham operation group (NLRP3 -/--S group), and NLRP3 -/- myocardial ischemia-reperfusion group (NLRP3 -/--IR group). The myocardial ischemia-reperfusion-induced brain injury model was established by ligating the left anterior descending coronary artery for 45 min followed by 24 h of reperfusion in anesthetized mice. The cognitive function was evaluated using the modified Morris water maze test at 24 h of reperfusion. The mice were sacrificed after blood specimens were collected, and brain tissues were obtained for measurement of the blood-brain barrier permeability and water content, for microscopic examination of the pathological changes of brain tissues, and for determination of serum S-100β protein and neuron-specific enolase (NSE) concentrations, contents of interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) in hippocampal tissues (by enzyme-linked immunosorbent assay), expression of NLRP3, apoptosis-associated speck-like protein (ASC), cleaved cysteine aspartate protease 1 (cleaved-caspase-1), gasdermin D (GSDMD), ionized calcium-binding adapter molecule 1 (Iba-1), and occludin in hippocampal tissues (by immunofluorescence and/or Western blot). The apoptosis rate of neurons and density of dendritic spine were calculated. Results:Compared with sham operation group, the escape latency was significantly prolonged, the number of crossing the original platform was decreased, and the time spent in the target quadrant was shortened, the concentrations of serum S-100β protein and NSE were increased, the blood-brain barrier permeability and brain water content were increased, the dendritic spine density in the hippocampal CA1 area was decreased, the contents of IL-1β, IL-6 and TNF-α were increased, the expression of NLRP3, ASC, cleaved-caspase-1, GSDMD and Iba-1 was up-regulated, and the expression of occludin was down-regulated ( P<0.05), and the pathological injury to brain tissues was found in ischemia-reperfusion group. Compared with W-IR group, the escape latency was significantly shortened, the number of crossing the original platform was increased, and the time spent in the target quadrant was prolonged, the concentrations of serum S-100β protein and NSE were decreased, the blood-brain barrier permeability and brain water content were decreased, the dendritic spine density in the hippocampal CA1 area was increased, the contents of IL-1β, IL-6 and TNF-α were decreased, the expression of NLRP3, ASC, cleaved-caspase-1, GSDMD and Iba-1 was down-regulated, and the expression of occludin was up-regulated ( P<0.05), and the pathological injury to brain tissues was alleviated in NLRP3 -/--IR group. Conclusions:NLRP3 inflammasome-mediated microglia activation is involved in myocardial ischaemia-reperfusion-induced brain injury in mice.
4.Tumor immune dysfunction and exclusion evaluation and chemoimmunotherapy response prediction in lung adenocarcinoma using pathomic-based approach.
Wei NIE ; Liang ZHENG ; Yinchen SHEN ; Yao ZHANG ; Haohua TENG ; Runbo ZHONG ; Lei CHENG ; Guangyu TAO ; Baohui HAN ; Tianqing CHU ; Hua ZHONG ; Xueyan ZHANG
Chinese Medical Journal 2025;138(3):346-348
5.The influence of enriched environment on cognitive impairment and GAP-43 content changes in pregnant mice with obstructive sleep apnea-hypopnea syndrome through regulating the NF-κB/NLRP3 pathway
Yunzhou Cheng ; Xueyan Li ; Yueming Zhang ; Rumeng Wei ; Yang Wang
Acta Universitatis Medicinalis Anhui 2025;60(7):1212-1217
Objective :
To investigate the effect of environmental enrichment on cognitive impairment and hippo- campus GAP-43 changes induced by exposure to obstructive sleep apnea-hypopnea syndrome ( OSAHS) during the period of late pregnancy in mice,and to explore relative inflammatory pathway mechanism.
Methods :
The experi- mental group of C57BL/6J pregnant mice were exposed to an intermittent hypoxic environment for 7 consecutive days starting from gestational day 15.The corresponding offspring were then placed in an enriched environment from postnatal day 21 to 2 months of age (designated as OSAHS + EE group) or in a normal environment (designat- ed as OSAHS group) .Pregnant mice in the control group were maintained in a normal oxygen environment,and their corresponding offspring were placed in an enriched environment (designated as Control + EE group) or a nor- mal environment (designated as Control group) at the same ages.The spatial learning and memory ability of the mice was assessed by Morris water maze at the age of 2 months.The mRNA levels of NF-kB,NLRP3 and GAP-43 in the hippocampus were detected by real-time fluorescence quantitative PCR , and the protein levels of NLRP3 and GAP-43 in the hippocampus were detected by Western blot.
Results:
Compared with Control group,the swimming distance increased (P<0. 01) ,and the percentage of swimming distance in target quadrant decreased (P<0. 01) in OSAHS group.The level of NF - κB mRNA,NLRP3 mRNA and protein in the hippocampus was increased,and the level of GAP-43 mRNA and protein was decreased (P<0. 01) .Compared with the Control group,there were no significant differences in swimming distance,percentage of swimming distance,NF-κB mRNA,NLRP3 mRNA and protein content in the OSAHS + EE group.
Conclusion
OSAHS during pregnancy impairs the learning and memory ability of offspring mice and reduces the level of GAP-43 protein.The mechanism may be related to the in- crease of NF-κB / NLRP3 level,and environmental enrichment can improve the damage.
6.Mechanism of Liangfang Wenjing Decoction in Regulating Endoplasmic Reticulum Stress to Reduce Apoptosis and Alleviate Ovarian Microvascular Injury in Rats with Cold Coagulation and Blood Stasis Syndrome
Tianyuan LYU ; Xueyan MA ; Yue HU ; Liqun FENG ; Xiaodan SONG ; Lianmin MEI ; Xiumei CHENG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(20):103-114
ObjectiveTo observe ovarian microvascular damage in rats with cold coagulation and blood stasis syndrome and to explore the mechanism by which Liangfang Wenjing decoction improves this condition in rats. MethodsFifty SPF female SD rats were randomly divided into a blank group, a model group, low-dose (8.1 g·kg-1) and high-dose groups (16.2 g·kg-1) of Liangfang Wenjing decoction, and a 4-phenylbutyric acid (0.1 g·kg-1) group, with 10 rats in each group. The ice-water bath method was employed to establish the rat model of cold coagulation and blood stasis syndrome. Concurrent with modeling, Liangfang Wenjing decoction was administered continuously for 21 days, once daily. The rats' syndrome manifestations and estrous cycles were recorded. The enzyme-linked immunosorbent assay (ELISA) was used to detect serum reproductive hormone levels and levels of endothelin-1 (ET-1), nitric oxide (NO), thrombomodulin (TM), and von Willebrand factor (vWF) in ovarian tissue. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) were measured. The ovarian microcirculatory blood perfusion was detected by laser speckle contrast imaging. Hematoxylin-eosin (HE) staining was performed to observe the ovarian histopathology, flow cytometry to detect ovarian apoptosis rate, and transmission electron microscopy to observe the ultrastructure of ovarian microvascular endothelial cells. Western blot was employed to detect the protein expression of endothelial nitric oxide synthase (eNOS), phosphorylated eNOS (p-eNOS), Caspase-3, B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP), inositol-requiring enzyme1α (IRE1α), p-IRE1α, apoptosis signal-regulating kinase 1 (ASK1), p-ASK1, c-Jun N-terminal kinase (JNK), and p-JNK. Immunofluorescence was used to detect ovarian Bax and Bcl-2 expression in microvascular endothelial cells. ResultsCompared with the blank group, the model group showed signs of cold coagulation and blood stasis syndrome, prolonged estrus cycles, and reproductive hormone disorders. Histopathological results revealed a decrease in follicle counts at all stages and disorganized granulosa cell arrangement. Ovarian microcirculatory perfusion was significantly decreased (P<0.01). PT, APTT, and TT were reduced (P<0.05, P<0.01), while FIB levels were increased (P<0.05). In ovarian tissue, NO content was decreased, while ET-1, vWF, and TM levels were increased significantly (P<0.01). The apoptosis rate of ovarian cells was markedly increased (P<0.01). Furthermore, p-eNOS/eNOS and Bcl-2 were decreased (P<0.05), whereas Bax, cleaved-Caspase-3/Caspase-3, GRP78, CHOP, p-IRE1α/IRE1α, p-ASK1/ASK1, and p-JNK/JNK expression showed significant increases (P<0.05, P<0.01). Compared with the model group, Liangfang Wenjing decoction intervention alleviated the symptoms of cold coagulation and blood stasis, gradually restored the estrus cycle, and improved ovarian histopathology and endothelial cell ultrastructure. Microcirculatory blood perfusion was significantly elevated (P<0.05). NO content in ovarian tissue was elevated, while ET-1, vWF, and TM levels were significantly decreased (P<0.05, P<0.01). The p-eNOS/eNOS ratio and Bcl-2 expression were significantly elevated (P<0.05), while the expression of Bax, cleaved-Caspase-3/Caspase-3, GRP78, CHOP, p-IRE1α/IRE1α, p-ASK1/ASK1, and p-JNK/JNK was significantly decreased (P<0.05, P<0.01). ConclusionLiangfang Wenjing decoction may regulate the IRE1α/ASK1/JNK signaling pathway to inhibit endoplasmic reticulum stress, attenuate apoptosis, and improve microvascular endothelial injury in ovaries of rats with cold coagulation and blood stasis syndrome.
7.Reliability and validity test of the Chinese version of the Urinary Incontinence Awareness and Attitude Scale
Zhiqiang CHENG ; Baozhen ZHANG ; Liping TANG ; Jing LI ; Jiaoyun XIA ; Xueyan WEI ; Zhixian GONG ; Meizhen ZHANG ; Lusi LI
Chinese Journal of Nursing 2025;60(9):1107-1112
Objective To translate the Urinary Incontinence Awareness and Attitude Scale(URINAS)and test its reliability and validity.Methods The Chinese version of the URINAS was developed by Brislin's translation model for translation,back translation,cultural adaptation,and pilot investigation.A convenience sampling method was used to select 384 urinary incontinence patients who visited a tertiary hospital in Nanchang,Jiangxi Province from June 2024 to October 2024 for investigation,in order to evaluate the reliability and validity of the scale.Results The Chinese version of the URINAS consisted of 5 dimensions with 26 entries.The Cronbach's alpha coefficient of this scale was 0.843;the folded half reliability was 0.917;the retest reliability was 0.852.The content validity of the scale at the level of the entries ranged from 0.846 to 1.000,and that at the level of the scale was 0.979.A total of 5 metrics were extracted by exploratory factor analysis,and the cumulative variance contribution rate of 74.286%.The results of the validation factor analysis showed a chi-square/degree of freedom of 2.268,a root mean square error of approximation of 0.064,a standardized fit index of 0.916,a Tucker-Lewis index of 0.923,a comparative fit index of 0.906,and a goodness-of-fit index of 0.922.Conclusion The URINAS has good reliability and validity,and can better reflect the level of patients' cognition and attitude towards urinary incontinence,thus providing theoretical basis for the development of corresponding intervention programs for such patients.
8.Role of NLRP3 inflammasome-mediated microglia activation in myocardial ischaemia-reperfusion-induced brain injury in mice
Hu CHENG ; Xiao CHENG ; Xueyan LI ; Yasen YALI ; Jianjiang WU ; Long YANG ; Wenbin YU ; Kuo ZHU ; Jiang WANG
Chinese Journal of Anesthesiology 2025;45(7):827-833
Objective:To evaluate the role of NOD-like receptor protein 3 (NLRP3) inflammasome-mediated microglia activation in myocardial ischaemia-reperfusion-induced brain injury in mice.Methods:Fifty-two SPF healthy male wild-type C57BL/6 mice and 52 NLRP3 -/- mice, aged 8-10 weeks, were divided into 4 groups ( n=26 each) using a random number table method: wild type sham operation group (W-S group), wild type myocardial ischemia-reperfusion group (W-IR group), NLRP3 -/- sham operation group (NLRP3 -/--S group), and NLRP3 -/- myocardial ischemia-reperfusion group (NLRP3 -/--IR group). The myocardial ischemia-reperfusion-induced brain injury model was established by ligating the left anterior descending coronary artery for 45 min followed by 24 h of reperfusion in anesthetized mice. The cognitive function was evaluated using the modified Morris water maze test at 24 h of reperfusion. The mice were sacrificed after blood specimens were collected, and brain tissues were obtained for measurement of the blood-brain barrier permeability and water content, for microscopic examination of the pathological changes of brain tissues, and for determination of serum S-100β protein and neuron-specific enolase (NSE) concentrations, contents of interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) in hippocampal tissues (by enzyme-linked immunosorbent assay), expression of NLRP3, apoptosis-associated speck-like protein (ASC), cleaved cysteine aspartate protease 1 (cleaved-caspase-1), gasdermin D (GSDMD), ionized calcium-binding adapter molecule 1 (Iba-1), and occludin in hippocampal tissues (by immunofluorescence and/or Western blot). The apoptosis rate of neurons and density of dendritic spine were calculated. Results:Compared with sham operation group, the escape latency was significantly prolonged, the number of crossing the original platform was decreased, and the time spent in the target quadrant was shortened, the concentrations of serum S-100β protein and NSE were increased, the blood-brain barrier permeability and brain water content were increased, the dendritic spine density in the hippocampal CA1 area was decreased, the contents of IL-1β, IL-6 and TNF-α were increased, the expression of NLRP3, ASC, cleaved-caspase-1, GSDMD and Iba-1 was up-regulated, and the expression of occludin was down-regulated ( P<0.05), and the pathological injury to brain tissues was found in ischemia-reperfusion group. Compared with W-IR group, the escape latency was significantly shortened, the number of crossing the original platform was increased, and the time spent in the target quadrant was prolonged, the concentrations of serum S-100β protein and NSE were decreased, the blood-brain barrier permeability and brain water content were decreased, the dendritic spine density in the hippocampal CA1 area was increased, the contents of IL-1β, IL-6 and TNF-α were decreased, the expression of NLRP3, ASC, cleaved-caspase-1, GSDMD and Iba-1 was down-regulated, and the expression of occludin was up-regulated ( P<0.05), and the pathological injury to brain tissues was alleviated in NLRP3 -/--IR group. Conclusions:NLRP3 inflammasome-mediated microglia activation is involved in myocardial ischaemia-reperfusion-induced brain injury in mice.
9.Prevalence and risk factors of food allergies among children in North China grassland: a cross-sectional study based on Zhangbei County, Hebei Province
Yang LIU ; Yanlei CHEN ; Yaojun PANG ; Ruijuan ZHANG ; Haiyun SHI ; Weiting JIN ; Wenhua MING ; Ye WANG ; Zilu CHENG ; Tingting MA ; Xueyan WANG
Chinese Journal of Preventive Medicine 2025;59(10):1725-1733
Objective:To determine the prevalence of self-reported food allergies among children in the grasslands of North China and to analyze its associated risk factors.Methods:In this study, a cross-sectional epidemiological survey method was used to select children under 14 years old by multi-stage, stratified and random cluster sampling in the grassland ecological area of Zhangbei County, Hebei Province, China from May to July 2018. Face-to-face questionnaires were administered to gather food allergy-related information from the participants. Multivariate logistic regression analysis was used to analyze the risk factors associated with self-reported food allergy.Results:A total of 2 086 children completed the survey. The prevalence of self-reported food allergies was 22.0%(459/2 086). The prevalence of multiple food allergies (≥3 types) was 3.1%(64/2 086) versus 16.3% (341/2 086) for a single food allergy among all children. Mango allergy (6.1%, 127/2 086) was the most common, followed by peach allergy (4.1%, 85/2 086). Children who reported food allergies had a significantly higher prevalence of all 4 atopic disorders (eczema, asthma, allergic rhinitis, and allergic conjunctivitis than those without food allergies(35.73% vs. 20.65%, 5.88% vs. 2.77%, 17.86% vs. 7.38%, 16.78% vs. 10.45%, χ2 =44.663 1, 10.434 3, 45.038 3, 13.728 4, all P<0.001).Significantly associated risk factors of food allergy were found to be pollen allergy ( OR: 2.29; 95% CI: 1.80-2.92) and drug allergy ( OR: 1.53; 95% CI: 1.12-2.09). Conclusions:The prevalence of self-reported food allergies among children in the Zhangbei County area of the North China Grassland was relatively high. Pollen allergy and drug allergy are major risk factors.
10.Association between estimated cumulative LDL-C exposure and coronary artery disease severity and 2-year prognosis in acute coronary syndrome patients
Yichun HAO ; 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
Chinese Journal of Cardiology 2025;53(3):274-280
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.

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