HDL-C/LDL-C与心肌梗死、全因死亡率、出血性卒中和缺血性卒中的关系:一项基于英国生物银行384 093名参与者的纵向研究。

IF 4.4 1区 医学 Q1 CLINICAL NEUROLOGY Stroke and Vascular Neurology Pub Date : 2023-04-01 DOI:10.1136/svn-2022-001668
Shiqi Yuan, Xiaxuan Huang, Wen Ma, Rui Yang, Fengshuo Xu, Didi Han, Tao Huang, MIn Peng, Anding Xu, Jun Lyu
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引用次数: 13

摘要

目的:探讨高密度脂蛋白胆固醇(HDL-C)/低密度脂蛋白胆固醇(LDL-C)与心肌梗死(MI)、全因死亡率、出血性卒中和缺血性卒中的相关性,以及遗传易感性和HDL-C/LDL-C与MI风险的联合关系。方法和结果:本研究从UK Biobank (UKB)数据库中选择384093名参与者。首先,受限三次样条曲线表明HDL-C/LDL-C与心肌梗死、缺血性卒中和全因死亡率呈非线性关联。其次,Cox比例风险模型显示,与HDL-C/LDL-C=0.4-0.6相比,HDL-C/LDL-C0.6与全因死亡率相关(HDL-C/LDL-C0.6的HR=0.97, 95% CI=1.16 ~ 1.26, p0.6与全多变量调整后的出血性卒中风险较高相关(HR=1.25, 95% CI=1.03 ~ 1.52, p0.6)。结论:在UKB参与者中,HDL-C/LDL-C比值0.4-0.6与较低的心肌梗死风险、全因死亡率、出血性卒中和缺血性卒中相关。HDL-C/LDL-C患者
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Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank.

Objective: To explore the correlations of high-density lipoprotein cholesterol (HDL-C)/low-density lipoprotein cholesterol (LDL-C) with myocardial infarction (MI), all-cause mortality, haemorrhagic stroke and ischaemic stroke, as well as the joint association of genetic susceptibility and HDL-C/LDL-C with the MI risk.

Methods and results: This study selected 384 093 participants from the UK Biobank (UKB) database. First, restricted cubic splines indicated non-linear associations of HDL-C/LDL-C with MI, ischaemic stroke and all-cause mortality. Second, a Cox proportional-hazards model indicated that compared with HDL-C/LDL-C=0.4-0.6, HDL-C/LDL-C<0.4 and >0.6 were correlated with all-cause mortality (HR=0.97 for HDL-C/LDL-C<0.4, 95% CI=0.939 to 0.999, p<0.05; HR=1.21 for HDL-C/LDL-C>0.6, 95% CI=1.16 to 1.26, p<0.001) after full multivariable adjustment. HDL-C/LDL-C<0.4 was correlated with a higher MI risk (HR=1.36, 95% CI=1.28 to 1.44, p<0.05) and ischaemic stroke (HR=1.12, 95% CI=1.02 to 1.22, p<0.05) after full multivariable adjustment. HDL-C/LDL-C>0.6 was associated with higher risk haemorrhagic stroke risk after full multivariable adjustment (HR=1.25, 95% CI=1.03 to 1.52, p<0.05). Third, after calculating the coronary heart disease Genetic Risk Score (CHD-GRS) of each participant, the Cox proportional-hazards model indicated that compared with low CHD-GRS and HDL-C/LDL-C=0.4-0.6, participants with a combination of high CHD-GRS and HDL-C/LDL-C<0.4 were associated with the highest MI risk (HR=2.45, 95% CI=2.15 to 2.8, p<0.001). Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS.

Conclusion: In UKB participants, HDL-C/LDL-C ratio of 0.4-0.6 was correlated with lower MI risk, all-cause mortality, haemorrhagic stroke and ischaemic stroke. Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS. The clinical significance and impact of HDL-C/LDL-C need to be further verified in future studies.

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来源期刊
Stroke and Vascular Neurology
Stroke and Vascular Neurology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
11.20
自引率
1.70%
发文量
63
审稿时长
15 weeks
期刊介绍: Stroke and Vascular Neurology (SVN) is the official journal of the Chinese Stroke Association. Supported by a team of renowned Editors, and fully Open Access, the journal encourages debate on controversial techniques, issues on health policy and social medicine.
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