低密度脂蛋白胆固醇、2 型糖尿病与主动脉瓣狭窄进展：RED-CARPET心脏瓣膜亚组队列研究》。

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Reviews in cardiovascular medicine Pub Date : 2024-08-07 eCollection Date: 2024-08-01 DOI:10.31083/j.rcm2508276

Jingjing He, Zhenyu Xiong, Odong Christopher, Zhuoshan Huang, Chaoguang Xu, Menghui Liu, Miaohong Li, Zhen Guo, Xinxue Liao, Xiaodong Zhuang

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引用次数: 0

摘要

背景：低密度脂蛋白胆固醇（LDL-C）和 2 型糖尿病（T2DM）都是主动脉狭窄（AS）的独立危险因素。在主动脉瓣狭窄患者中，低密度脂蛋白胆固醇或 T2DM 是否与主动脉瓣狭窄快速进展（FASP）有关以及它们之间的相互作用尚不清楚。本研究旨在验证一个假设，即当 LDL-C 升高与 T2DM 同时存在时，FASP 的风险会增加：心脏代谢保护的真实世界数据（RED-CARPET）研究在 2015 年 1 月至 2020 年 12 月期间在一个中心招募了患有轻度（主动脉峰值速度 = 2-3 m/s）、中度（3-4 m/s）和重度（≥ 4 m/s）AS 的参与者。参与者按基线低密度脂蛋白胆固醇（LDL-C）和T2DM进一步分层，6个月后进行超声心动图随访，主要结果为FASP，定义为主动脉峰值速度的年变化（≥ 0.3 m/s/年）：在 170 名参与者中，45.3% 患有轻度 AS，41.2% 患有中度 AS，13.5% 患有重度 AS。平均年龄为（66.84 ± 12.64）岁，64.1%为女性。在 2.60 ± 1.43 年的随访期间，发现了 35 例（20.6%）FASP 病例。以 LDL-C 2.15 mmol/L 的非 T2DM 为参照，LDL-C 2.15-3.14 mmol/L 的非 T2DM 的 FASP 风险为 1.30 [几率比（OR），95% CI（0.99-7.78，P = 0.167）]，LDL-C ≥ 3.14 mmol/L 的非 T2DM 的 FASP 风险为 1.60 [OR，95% CI（1.17-3.29，P = 0.040）]，LDL-C ≥ 3.14 mmol/L 的非 T2DM 的 FASP 风险为 2.21 [OR, 95% CI (0.49-4.32, p = 0.527)]，LDL-C 2.15 mmol/L的T2DM为2.67 [OR, 95% CI (1.65-7.10, p = 0.004)]，LDL-C 2.15-3.14 mmol/L的T2DM为3.20 [OR, 95% CI (1.07-5.34, p = 0.022)]：低密度脂蛋白胆固醇（LDL-C）联合 T2DM 与 FASP 相关。这项调查表明，如果 T2DM 患者的低密度脂蛋白胆固醇控制不佳，强直性脊柱炎可能会快速发展。需要进行更多的研究来验证这一发现，并探索可能的生物学机制，以改善 T2DM 的心脏代谢管理，并寻求预防该人群 AS 进展的可能方法：临床试验注册：ChiCTR2000039901 (https://www.chictr.org.cn)。

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Low-Density Lipoprotein Cholesterol, Type 2 Diabetes and Progression of Aortic Stenosis: The RED-CARPET Heart Valve Subgroup Cohort Study.

Background: Low-density lipoprotein cholesterol (LDL-C) and type 2 diabetes (T2DM) are both independent risk factors for aortic stenosis (AS). In AS patients, whether LDL-C or T2DM is associated with fast AS progression (FASP) and their interaction is unknown. This study aims to test the hypothesis that there is a heightened risk of FASP when elevated LDL-C coexists with T2DM.

Methods: The Real-world Data of Cardiometabolic Protections (RED-CARPET) study enrolled participants with mild (peak aortic velocity = 2-3 m/s), moderate (3-4 m/s) and severe ( $\geq$ 4 m/s) AS between January 2015 and December 2020 at a single center. Participants were further stratified by baseline LDL-C joint T2DM, follow-up echocardiography was performed after 6 months, and the primary outcome was FASP, defined as the annual change in aortic peak velocity ( $\geq$ 0.3 m/s/year).

Results: Among the 170 participants included, 45.3% had mild AS, 41.2% had moderate AS, and 13.5% had severe AS. The mean age was 66.84 $\pm$ 12.64 years, and 64.1% were women. During the follow-up period of 2.60 $\pm$ 1.43 years, 35 (20.6%) cases of FASP were identified. Using non-T2DM with LDL-C $<$ 2.15 mmol/L as reference, FASP risk was 1.30 [odds ratio (OR), 95% CI (0.99-7.78, p = 0.167)] for non-T2DM with LDL-C 2.15-3.14 mmol/L, 1.60 [OR, 95% CI (1.17-3.29, p = 0.040)] for non-T2DM with LDL-C $\geq$ 3.14 mmol/L, 2.21 [OR, 95% CI (0.49-4.32, p = 0.527)] for T2DM with LDL-C $<$ 2.15 mmol/L, 2.67 [OR, 95% CI (1.65-7.10, p = 0.004)] for T2DM with LDL-C 2.15-3.14 mmol/L, and 3.20 [OR, 95% CI (1.07-5.34, p = 0.022)] for T2DM with LDL-C $\geq$ 3.14 mmol/L.

Conclusions: LDL-C joint T2DM was associated with FASP. This investigation suggests that fast progression of AS may develop if LDL-C is poorly managed in T2DM. Additional research is needed to validate this finding and explore the possible biological mechanism to improve the cardiometabolic management of T2DM and seek possible prevention for AS progression for this population.

Clinical trial registration: ChiCTR2000039901 (https://www.chictr.org.cn).

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.