Clinica e Investigacion en Arteriosclerosis最新文献

Comparative performance of machine learning vs classical formulas for LDL-cholesterol calculation. 机器学习与ldl -胆固醇计算经典公式的比较性能。

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-12-08 DOI: 10.1016/j.arteri.2025.500887

Salomón Martín Pérez, Remo Suppi, Teresa Arrobas Velilla, Francisco de Borja Téllez Hernández, Antonio León-Justel

Introduction: Low-density lipoprotein cholesterol (LDL-C) is a significant cardiovascular risk factor, as direct measurement is expensive and often unavailable in most clinical laboratories. The Friedewald formula (FD), despite its widespread use since 1972, has notable limitations, especially at high triglyceride levels and low LDL-C concentrations. Machine learning (ML) techniques offer promising alternatives for accurate LDL-C estimation, potentially overcoming traditional formula limitations by leveraging complex pattern recognition in lipid profile data.

Material and methods: This retrospective study analyzed 34,678 lipid profiles from patients over 18 years attending Hospital Virgen Macarena, Seville (January 2021-December 2022). The study was approved by the Ethics Committee (CEI HVM-VR_03/2024). All lipid parameters (total cholesterol, triglycerides, HDL-C, LDL-C) were measured using Cobas 6000 analyzer. Twenty-two machine learning models were developed using Python's PyCaret library with 80/20 train-test split. Models included Linear Regression, Random Forest, XGBoost, LightGBM, and Gradient Boosting among others. Performance was evaluated using coefficient of determination (R²), mean absolute error (MAE), and root mean square error (RMSE). Four triglyceride subgroups were analyzed: <150, 150-250, 250-400, and >400mg/dL.

Results: The dataset comprised 34,678 individuals with mean values: total cholesterol 204.6±73.36mg/dL, triglycerides 203.95±143.94mg/dL, HDL-C 51.83±18.45mg/dL, and LDL-C 120.38±62.29mg/dL. LightGBM achieved the highest performance (R²=0.965, RMSE=11.35, MAE=7.99), followed by Gradient Boosting (R²=0.962, RMSE=11.89, MAE=7.87) and XGBoost (R²=0.958, RMSE=12.49, MAE=8.3). Traditional formulas showed inferior performance: Martin-Hopkins (R²=0.951, RMSE=13.82, MAE=9.3) and Friedewald (R²=0.926, RMSE=16.92, MAE=11.97). Performance differences were more pronounced at triglyceride levels≥250mg/dL, with ML models maintaining R²>0.92 while classical formulas deteriorated significantly, particularly Friedewald (R²=0.34) at triglycerides>400mg/dL.

Conclusions: Machine learning models, particularly boosting algorithms (LightGBM, Gradient Boosting, XGBoost), significantly outperformed traditional LDL-C calculation formulas across all triglyceride ranges. These AI-based approaches yielded superior accuracy and robustness, especially in challenging clinical scenarios with elevated triglycerides where conventional formulas fail. Implementation of ML models in clinical laboratories could provide more reliable LDL-C estimations, contributing to improved cardiovascular risk stratification and patient management. This technological advancement represents a promising transformation in laboratory medicine methodology.

低密度脂蛋白胆固醇（LDL-C）是一个重要的心血管危险因素，因为直接测量是昂贵的，而且在大多数临床实验室通常无法获得。弗里德瓦尔德公式（FD），尽管自1972年以来被广泛使用，但有明显的局限性，特别是在高甘油三酯水平和低LDL-C浓度时。机器学习（ML）技术为准确估计LDL-C提供了有希望的替代方法，通过利用脂质谱数据中的复杂模式识别，有可能克服传统公式的限制。材料和方法：本回顾性研究分析了来自塞维利亚Virgen Macarena医院（2021年1月至2022年12月）18年以上患者的34,678例脂质谱。该研究已获得伦理委员会批准（CEI HVM-VR_03/2024）。所有脂质参数（总胆固醇、甘油三酯、HDL-C、LDL-C）均采用Cobas 6000分析仪测定。使用Python的PyCaret库以80/20训练-测试分割开发了22个机器学习模型。模型包括线性回归、随机森林、XGBoost、LightGBM和梯度增强等。使用决定系数（R2）、平均绝对误差（MAE）和均方根误差（RMSE）对性能进行评价。分析了四个甘油三酯亚组：400mg/dL。结果：该数据集包括34,678名个体，平均值：总胆固醇204.6±73.36mg/dL，甘油三酯203.95±143.94mg/dL, HDL-C 51.83±18.45mg/dL, LDL-C 120.38±62.29mg/dL。LightGBM的效果最好（R2=0.965， RMSE=11.35， MAE=7.99），其次是Gradient Boosting （R2=0.962， RMSE=11.89， MAE=7.87）和XGBoost （R2=0.958， RMSE=12.49， MAE=8.3）。传统配方的疗效较差：Martin-Hopkins （R2=0.951， RMSE=13.82， MAE=9.3）和Friedewald （R2=0.926， RMSE=16.92， MAE=11.97）。当甘油三酯水平≥250mg/dL时，性能差异更为明显，ML模型的R2维持在0.92，而经典公式的R2明显恶化，特别是在甘油三酯水平400mg/dL时，Friedewald （R2=0.34）。结论：机器学习模型，特别是增强算法（LightGBM, Gradient boosting, XGBoost），在所有甘油三酯范围内都明显优于传统的LDL-C计算公式。这些基于人工智能的方法产生了卓越的准确性和稳健性，特别是在具有挑战性的甘油三酯升高的临床场景中，传统的配方失败了。在临床实验室实施ML模型可以提供更可靠的LDL-C估计，有助于改善心血管风险分层和患者管理。这一技术进步代表了检验医学方法论的一个有希望的转变。

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引用次数: 0

Telomere length is associated with arterial damage in the CORDIOPREV study. 在CORDIOPREV研究中，端粒长度与动脉损伤有关。

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-12-02 DOI: 10.1016/j.arteri.2025.500878

Ana Ojeda-Rodriguez, Maria Jose Parraga-Viudez, Alejandro López-Moreno, Alejandro Serrán-Jiménez, Alberto Díaz-Cáceres, Javier Arenas-Montes, José D Torres-Peña, Justo P Castaño, Javier Delgado-Lista, José López-Miranda

Background: Telomere length (TL) has emerged as a recognized biomarker of biological aging and cardiovascular risk. Several studies have associated short TL with increased incidence of cardiovascular disease and adverse outcomes. However, its value as a predictor of arterial injury remains unclear, especially in secondary prevention. This study examined the baseline association between TL and common carotid intima-media thickness (IMT-CC) in patients with coronary heart disease (CHD).

Methods: Of the 1002 CHD patients enrolled in the CORDIOPREV study, 903 completed baseline assessments of IMT-CC and TL. IMT-CC was measured bilaterally using high-resolution B-mode Doppler ultrasonography and categorized, according to the European Society of Cardiology guidelines, into three groups reflecting arterial injury: <0.7mm, 0.7-0.9mm, and ≥0.9mm. TL was determined using the quantitative PCR method. Patients were classified as at risk of short TL if their value was below the 20th percentile, and as non-risk if above this threshold.

Results: Patients with the highest IMT-CC values (≥0.9mm) had significantly shorter TL compared to those in the lowest group (<0.7mm, p=0.005), with a progressive decrease across IMT-CC categories (p for trend=0.02). The proportion of participants at risk of short telomeres increased significantly from 15% to 30% across these categories (p<0.001). In addition, the highest IMT-CC group showed a twofold greater risk of short telomeres compared to the reference group (<0.7mm; OR 2.373, 95%CI 1.4962-3.764), while no significant association was observed for the intermediate IMT-CC group (0.7-0.9mm; OR 1.352, 95%CI 0.896-2.039).

Conclusions: In CHD patients, shorter TL is associated to advanced subclinical arterial damage, supporting its potential role as a complementary biomarker for vascular aging and improved risk stratification in secondary prevention.

背景：端粒长度（TL）已成为公认的生物衰老和心血管风险的生物标志物。一些研究表明，短TL与心血管疾病发病率增加和不良后果有关。然而，其作为动脉损伤预测指标的价值尚不清楚，特别是在二级预防方面。本研究探讨了冠心病（CHD）患者TL与颈总动脉内膜-中膜厚度（IMT-CC）之间的基线相关性。方法：在纳入CORDIOPREV研究的1002例冠心病患者中，903例完成了IMT-CC和TL的基线评估。IMT-CC采用高分辨率b型多普勒超声双侧测量，并根据欧洲心脏病学会指南分为反映动脉损伤的三组：结果：IMT-CC值最高的患者（≥0.9mm）的TL明显短于IMT-CC值最低的患者。在冠心病患者中，较短的TL与晚期亚临床动脉损伤相关，支持其作为血管老化和改善二级预防风险分层的补充生物标志物的潜在作用。

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引用次数: 0

Utilidad de la grasa corporal y visceral determinada por bioimpedanciometría frente al índice de masa corporal y el perímetro de cintura en la identificación de valores elevados de diferentes escalas de riesgo de aterogénesis 生物阻抗测定的身体和内脏脂肪与体重指数和腰围在识别不同动脉粥样硬化风险等级升高值中的作用

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500772

María Gordito Soler , José Ignacio Ramírez-Manent , Pedro Juan Tárraga López , Emilio Martínez-Almoyna Rifá , Hernán Paublini , Ángel Arturo López González

Introduction

Obesity and atherogenesis are two highly prevalent pathological processes worldwide that also share several pathophysiological mechanisms.

Objectives

Descriptive and cross-sectional study in 8,590 Spanish workers (4,104 men and 4,486 women) with an average age of 41.5 years, in which the usefulness of four scales of overweight and obesity such as body mass index (BMI), waist circumference and percentages of body and visceral fat determined by bioimpedance measurement to identify high levels of atherogenic risk determined by atherogenic dyslipidemia (AD), lipid triad (LT) and several atherogenic indices is assessed.

Results

All the overweight and obesity scales show a predictive value between moderate and good, determined by the AUC of the ROC curves, with values ranging from 0.727 to 0.886 in women and 0.676 to 0.885 in men. Of all of them, the one with the highest AUC is visceral fat with values exceeding 0.800 and the lowest are for BMI. In all cases, the AUC is higher in women.

Conclusions

The overweight and obesity scales analysed (BMI, waist circumference and percentage of body and visceral fat) show AUCs for predicting atherogenic risk between moderate and high, with visceral fat being the most useful of all.

肥胖和动脉粥样硬化是世界范围内两种非常普遍的病理过程，它们也有一些共同的病理生理机制。目的：对平均年龄为41.5岁的8,590名西班牙工人（4,104名男性和4,486名女性）进行描述性和横断面研究，评估四种超重和肥胖量表的有效性，如体重指数（BMI）、腰围和生物阻抗测量确定的身体和内脏脂肪百分比，以确定由动脉粥样硬化性血脂异常（AD）、脂质三联症（LT）和几种动脉粥样硬化指标确定的高水平动脉粥样硬化风险。结果：通过ROC曲线的AUC，所有超重和肥胖量表的预测值均介于中度和良好之间，女性的预测值为0.727 ~ 0.886，男性的预测值为0.676 ~ 0.885。其中，AUC最高的是内脏脂肪，其值超过0.800，最低的是BMI。在所有情况下，女性的AUC都较高。结论：所分析的超重和肥胖量表（BMI、腰围、身体和内脏脂肪百分比）显示，auc在预测动脉粥样硬化风险方面处于中等和高度之间，其中内脏脂肪是最有用的。

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引用次数: 0

Myeloproliferative neoplasms: A model of the journey from clonal hematopoiesis to cardiovascular disease and cancer 骨髓增生性肿瘤：从克隆造血到心血管疾病和癌症的一个模型。

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500767

Santiago Redondo

In the last decade, the coming of next-generation sequencing and its application to large human populations is breaking the barrier between inflammation and cancer. Indeed, acquired mutations in key genes that regulate hematopoiesis and thus confer a selective advantage in the proliferation of hematopoietic progenitors have established the concept of clonal hematopoiesis of indeterminate potential or CHIP. A growing body of clinical and experimental evidence is highlighting the link between CHIP and adverse outcomes, in particular atherosclerotic cardiovascular disease and cancer. The apparent surprise about how these two different entities share common mechanisms can be explained by myeloproliferation and inflammation. These mechanisms are involved not only in the development of myeloid tumors but also in atherogenesis. Myeloproliferative neoplasms or MPN are a type of myeloid tumors where thrombotic risk is increased not only by higher blood counts but also by means of an accelerated atherosclerosis. Therefore, myeloproliferative neoplasms are a model of the link between clonal hematopoiesis and atherosclerotic cardiovascular disease. The concept of CHIP has important clinical applications. A deeper understanding of these mechanisms may pave the way for the future early diagnosis and potential pre-emptive treatments of these two major causes of death.

在过去的十年中，下一代测序技术的到来及其在大量人群中的应用正在打破炎症和癌症之间的屏障。事实上，调节造血的关键基因的获得性突变，从而赋予造血祖细胞增殖的选择性优势，已经建立了不确定电位克隆造血或CHIP的概念。越来越多的临床和实验证据正在强调CHIP与不良后果之间的联系，特别是动脉粥样硬化性心血管疾病和癌症。骨髓增生和炎症可以解释这两种不同的实体如何共享共同的机制。这些机制不仅涉及髓系肿瘤的发展，也涉及动脉粥样硬化的发生。髓细胞增生性肿瘤或MPN是一种髓系肿瘤，其血栓形成的风险不仅通过较高的血球计数增加，而且通过加速动脉粥样硬化的方式增加。因此，骨髓增生性肿瘤是克隆造血和动脉粥样硬化性心血管疾病之间联系的一个模型。CHIP的概念具有重要的临床应用。对这些机制的深入了解可能为未来对这两种主要死亡原因的早期诊断和潜在的先发制人的治疗铺平道路。

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引用次数: 0

Impact of therapeutic inertia in lipid-lowering therapy in patients at very high cardiovascular risk 治疗惯性对高危心血管患者降脂治疗的影响

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500773

Juan Cosín Sales , Carlos Escobar Cervantes , José Javier Gómez-Barrado , José Manuel Andreu Cayuelas , Abel García del Egido , Jorge Joaquín Castro Martín , Ana Isabel Huelmos Rodrigo , Miguel Corbi-Pascual , Ariana Varela Cancelo , Rafael Vidal-Pérez , Leticia Fernandez-Friera , Enrique Santas Olmeda , Almudena Aguilera-Saborido , Antonio Fernández Romero , Antonio Sánchez Hidalgo , Francisco Pérez-Sádaba , Román Freixa-Pamias

Aims

A high number of patients do not achieve the therapeutic goals set by clinical practice guidelines, despite the therapeutic alternatives that currently exist in lipid-lowering treatment (LLT). This study aimed to estimate the proportion of patients who have recently suffered an acute coronary syndrome (ACS) who do not meet the therapeutic goal with LLT and the proportion of routine follow-up visits where therapeutic inertia (TI) occurs.

Methods

A retrospective study chart review was conducted in 13 Spanish centres. Patients aged ≥18 years who suffered an ACS event in the last two years and had received LLT were included. Sociodemographic, clinical, treatment and participating centre/physician-related variables were collected. TI was considered when a visit did not result in a change in the patient's therapy despite the non-achievement of therapeutic goals. Descriptive analysis was performed, and factors associated with TI were evaluated using logistic regression.

Results

159 patients were included (mean age 63.08 years old, 80.5% male) and 338 follow-up visits were analysed. Over 50% of the patients did not meet the therapeutic target and TI was estimated in 39.13% of visits. Some factors were associated with a lower risk of TI: professional experience, number of vessels affected, and diabetes. And others with higher risk: being female, previous CV pathology and a complete revascularisation.

Conclusion

The management of patients after ACS is still suboptimal. The importance of clinical inertia in ACS remains a real awareness and active strategies will help mitigate this phenomenon due to the risk of recurrent ACS.

目的：尽管目前存在降脂治疗（LLT）的治疗方案，但仍有大量患者未达到临床实践指南设定的治疗目标。本研究旨在估计近期急性冠脉综合征（ACS）患者在LLT治疗中未达到治疗目标的比例，以及常规随访中出现治疗惰性（TI）的比例。方法：对13个西班牙中心进行回顾性研究。年龄≥18岁且在过去两年内发生过ACS事件并接受过LLT的患者被纳入研究。收集社会人口学、临床、治疗和参与中心/医生相关变量。当访问没有导致患者治疗的改变，尽管没有达到治疗目标时，TI被考虑。进行描述性分析，并使用逻辑回归评估与TI相关的因素。结果：共纳入159例患者，平均年龄63.08岁，男性80.5%，随访338次。超过50%的患者没有达到治疗目标，估计有39.13%的患者有TI。一些因素与较低的TI风险相关：专业经验、受影响的血管数量和糖尿病。其他高风险人群：女性、既往心血管病变和完全血管重建。结论：急性冠脉综合征后患者的管理仍不理想。临床惯性在ACS中的重要性仍然是一个真正的意识和积极的策略将有助于减轻这种现象，由于ACS复发的风险。

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引用次数: 0

Utilidad del estudio de la grasa visceral para una estratificación precoz del riesgo aterogénico: de la antropometría convencional a las medidas más precisas 内脏脂肪研究对动脉粥样硬化风险的早期分层的作用：从传统的人体测量到最精确的测量

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500874

Francisco Martín Luján , Rosa Solà Alberich

引用次数: 0

No association between LDL cholesterol levels and cellular membrane integrity assessed with phase angle: Insights from the MALIPID study 低密度脂蛋白胆固醇水平和用相位角评估的细胞膜完整性之间没有关联：来自MALIPID研究的见解。

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500846

Joanna Popiolek-Kalisz

Background

Although aggressive low-density lipoprotein cholesterol (LDL-C) reduction has demonstrated significant cardiovascular benefits, concerns have emerged regarding potential adverse effects of very low LDL-C on cellular functions, particularly membrane integrity as cholesterol constitutes an essential component of cellular membranes. The phase angle (PhA), derived from bioelectrical impedance analysis (BIA) reflects cellular membranes integrity and nutritional status. The MALIPID study aimed to assess if LDL-C levels are associated with PhA in high cardiovascular risk patients.

Methods

A cross-sectional study was conducted in 140 patients matched 1:1 for age, sex, and body mass index, stratified by LDL-C levels (<55 vs. ≥55 mg/dL). Laboratory parameters, anthropometry, and BIA measurements were collected with PhA at 50 kHz as the primary outcome.

Results

Median PhA values were comparable between LDL-C groups (4.88 vs. 4.93; p = 0.67). LDL-C was not significantly associated with PhA multivariable regression models adjusted for age, sex, fat-free mass, and biochemical parameters. PhA significantly inversely correlated with age (R = −0.60, p < 0.0001) and positively with eGFR (R = 0.38, p < 0.0001), but not with LDL-C. Subgroup analyses in patients aged >75 years also presented lack of relationship between LDL-C and PhA.

Conclusions

No association was found between LDL-C levels and cellular membrane integrity assessed by PhA. These findings potentially support the physiological safety of intensive LDL-C reduction and highlight the dominant role of age and body composition in determining PhA. Larger, prospective studies are needed to confirm these results.

背景：尽管积极降低低密度脂蛋白胆固醇（LDL-C）已显示出显著的心血管益处，但人们开始关注极低的LDL-C对细胞功能的潜在不良影响，特别是膜完整性，因为胆固醇是细胞膜的重要组成部分。由生物电阻抗分析（BIA）得出的相位角（PhA）反映了细胞膜的完整性和营养状况。MALIPID研究旨在评估高危心血管患者LDL-C水平是否与PhA相关。方法：对140例年龄、性别和体重指数1:1匹配的患者进行横断面研究，按LDL-C水平分层(结果：LDL-C组间PhA值中位数具有可比性（4.88 vs 4.93; p=0.67）。LDL-C与PhA多变量回归模型无显著相关性，校正了年龄、性别、无脂量和生化参数。PhA与年龄呈显著负相关（R=-0.60， p75岁时LDL-C与PhA也无相关性）。结论：LDL-C水平与PhA评估的细胞膜完整性之间没有关联。这些发现潜在地支持了强化LDL-C降低的生理安全性，并强调了年龄和身体成分在决定PhA中的主导作用。需要更大规模的前瞻性研究来证实这些结果。

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引用次数: 0

Análisis de la determinación de lipoproteína (a) en una selección de laboratorios clínicos españoles. Estudio Batary 脂蛋白(a)测定在西班牙临床实验室的选择分析。Batary研究。

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-11-01 DOI: 10.1016/j.arteri.2025.500798

Teresa Arrobas Velilla , Salomon Martin Perez , Carla Fernández Prendes , Maria Jose Castro Castro , Silvia Camos Anguila , Antonio Leon Justel

Introduction

Lipoprotein a is considered an independent factor of atherosclerotic cardiovascular disease with high prevalence, but the availability of real and updated data in Spain as well as determination protocols are limited.

Main objective

Analyze the current state of the pre-analytical, analytical and post-analytical process of Lp (a) and assess the relationship with other variables.

Material and method

Retrospective, observational, multicenter, anonymized study carried out in 2022 by survey of clinical laboratories.

Results

21,926 determinations were obtained corresponding to 49 Laboratories. The values obtained were: Lp(a) >30 mg/dl = 46.87%, Lp(a) >50 mg/dl 35.31%, Lp(a) >70 mg/dl = 26.8% Lp(a) >90 mg/dl = 19.3% with predominance of superiority in female gender in all established cut-off points.

Almost 30% of primary care doctors do not have access to their application. 56.9% do not have a rejection criterion. 70.6% do not have protocols for its determination.

There are two predominant analytical techniques, Immunophelometry (40%) and immunoturbidimetry (60%), 24% use nmon/L, 68% mg/dL and 8% report both.

Conclusions

There is a low number of patients who have Lp(a) measured and of them the percentage of patients according to risk cut-off points are higher than those described. There is a lack of uniformity in pre-analytical, analytical and post-analytical processes in which it is necessary to work in a multidisciplinary manner to avoid future cardiovascular events.

脂蛋白a被认为是高患病率的动脉粥样硬化性心血管疾病的独立因素，但西班牙真实和最新数据的可用性以及测定方案有限。主要目的：分析Lp (a)的前分析、分析和后分析过程的现状，并评估其与其他变量的关系。材料与方法：回顾性、观察性、多中心、匿名研究，于2022年开展临床实验室调查。结果：49个实验室共检测21926次。所得值为：Lp(a)>30mg/dl=46.87%, Lp(a)>50mg/dl = 35.31%, Lp(a)>70mg/dl=26.8%, Lp(a)>90mg/dl=19.3%，在所有已建立的分界点上，女性优势优势明显。近30%的初级保健医生无法获得其应用程序。56.9%没有拒绝标准。70.6%没有检测方案。有两种主要的分析技术，免疫比浊法（40%）和免疫比浊法（60%），24%使用nmon/L， 68%使用mg/dL， 8%同时使用。结论：测量Lp(a)的患者数量较少，其中根据风险分界点的患者百分比高于描述的患者百分比。在分析前、分析和分析后的过程中缺乏一致性，有必要以多学科的方式工作，以避免未来的心血管事件。

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引用次数: 0

Atherogenic risk in normal-weight workers: Associations with sociodemographic and healthy lifestyle factors using lipid-based indexes. 正常体重工人的动脉粥样硬化风险：使用基于脂质指数的社会人口统计学和健康生活方式因素

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-10-21 DOI: 10.1016/j.arteri.2025.500871

Claudia Isabella Tirado Cabrera, Daniel Guzmán Capote, Pedro Juan Tárraga López, Ángel Arturo López-González

Background: Atherogenic dyslipidemia is a significant but often underrecognized cardiovascular risk factor in individuals with normal weight. Traditional metrics such as body mass index (BMI) may fail to identify metabolically unhealthy phenotypes. This study aimed to assess the prevalence and sociodemographic and lifestyle determinants of atherogenic risk using lipid-based indices in a large cohort of normal-weight Spanish workers.

Methods: A cross-sectional study was conducted in a sample of 166,008 normal-weight workers (BMI 18.5-24.9kg/m²). Four atherogenic risk indices were calculated: TC/HDL-c, LDL/HDL-c, TG/HDL-c, and a composite Dyslipidemia Atherogenic Index (DA). Multivariate logistic regression analyses were performed to assess associations with age, sex, educational level, occupational category (CNAE-11), physical activity (IPAQ), adherence to the Mediterranean diet (MEDAS), smoking, and alcohol consumption.

Results: Male sex, older age, low physical activity, and poor adherence to the Mediterranean diet were independently associated with elevated values in all four atherogenic indices. The strongest associations were observed for DA with sedentary lifestyle (OR: 9.15; 95% CI: 8.08-10.23) and poor diet quality (OR: 5.23; 95% CI: 4.39-6.07). Notably, 17-22% of normal-weight workers showed abnormal lipid ratios suggestive of increased cardiometabolic risk.

Conclusions: Normal BMI does not guarantee cardiometabolic health. A considerable proportion of normal-weight individuals exhibit lipid profiles consistent with atherogenic dyslipidemia, largely driven by modifiable lifestyle factors. Lipid-based indices are valuable tools for early risk identification in occupational settings and should complement traditional anthropometric screening.

背景：在体重正常的个体中，动脉粥样硬化性血脂异常是一个重要但常被忽视的心血管危险因素。身体质量指数（BMI）等传统指标可能无法识别代谢不健康的表型。本研究旨在评估患病率和社会人口和生活方式的动脉粥样硬化风险的决定因素，使用血脂为基础的指数在一个大队列正常体重的西班牙工人。方法：对166,008名正常体重工人（BMI 18.5-24.9kg/m2）进行横断面研究。计算四种致动脉粥样硬化风险指数：TC/HDL-c、LDL/HDL-c、TG/HDL-c和复合血脂异常致动脉粥样硬化指数（DA）。进行多变量logistic回归分析以评估与年龄、性别、教育水平、职业类别（CNAE-11）、身体活动（IPAQ）、地中海饮食（MEDAS）依从性、吸烟和饮酒的关系。结果：男性、年龄较大、低体力活动和地中海饮食依从性差与所有四种动脉粥样硬化指数升高独立相关。观察到DA与久坐生活方式（OR: 9.15; 95% CI: 8.08-10.23）和不良饮食质量（OR: 5.23; 95% CI: 4.39-6.07）的相关性最强。值得注意的是，17-22%的正常体重工人显示异常脂质比率，提示心脏代谢风险增加。结论：正常的BMI并不能保证心脏代谢健康。相当比例的正常体重个体表现出与动脉粥样硬化性血脂异常一致的脂质谱，主要由可改变的生活方式因素驱动。在职业环境中，以脂质为基础的指数是早期风险识别的有价值的工具，应该补充传统的人体测量筛查。

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引用次数: 0

Relationship between apolipoprotein(a) isoforms and lipoprotein(a) levels in patients with acute coronary syndrome. 急性冠状动脉综合征患者载脂蛋白(a)亚型与脂蛋白(a)水平的关系

IF 1.9 Q3 PERIPHERAL VASCULAR DISEASE

Clinica e Investigacion en Arteriosclerosis

Pub Date : 2025-10-18 DOI: 10.1016/j.arteri.2025.500870

Rosa Fernández-Olmo, Jesús Lara Mariscal, Ana García Ruano, Alberto Cordero, Juan Manuel Castillo Casas, Diego Franco

Lp(a) is a cardiovascular risk factor influenced by the LPA gene and apo(a) isoforms. Their relationship is not always linear and there are discordant phenotypes, for this reason in our work we evaluated the association between apo(a) isoforms and Lp(a) levels in patients with acute coronary syndrome (ACS). To this end, 43 patients with ACS and Lp(a) >50mg/dL were studied. The isoforms were characterized in 12bands by Western blotting. The association between bands and Lp(a) concentrations was evaluated by statistical analysis. It was observed that the intermediate molecular weight bands (b5-b8) were the most frequent, with band 8 predominating. No significant association was found between isoform size and Lp(a) levels (P>.05). We conclude that in this cohort no correlation was observed between apo(a) and Lp(a) isoforms. Other genetic or regulatory mechanisms could explain the observed variability, supporting the need for larger studies.

Lp(a)是受LPA基因和载脂蛋白(a)亚型影响的心血管危险因素。它们的关系并不总是线性的，并且存在不一致的表型，因此在我们的工作中，我们评估了急性冠脉综合征（ACS）患者载脂蛋白(a)亚型和脂蛋白(a)水平之间的关系。为此，我们对43例ACS患者进行了Lp(a) bb0 50mg/dL的研究。Western blotting将其分为12个条带。通过统计分析评估波段与Lp(a)浓度之间的关系。结果表明，中间分子量带（b5 ~ b8）最为常见，以8带居多。异构体大小与Lp(a)水平无显著相关性（P < 0.05）。我们得出结论，在这个队列中，载脂蛋白(a)和脂蛋白(a)亚型之间没有相关性。其他遗传或调节机制可以解释观察到的差异，支持需要进行更大规模的研究。

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