EHJ:临床大发现:降脂还只知道LDL-C?残余胆固醇才是“罪魁祸首”!

2021-09-26 MedSci原创 MedSci原创

无论LDL-C水平如何,残余胆固醇(RC)水平≥24 mg/dL,动脉粥样硬化相关性疾病的发生风险升高

根据既往认知,大家都已认定血液中的胆固醇和甘油三酯是血脂管理的重中之重,同时可以预测血管事件(CVD)的发生风险。其中,高密度脂蛋白(HDL)和低密度脂蛋白(LDL)是胆固醇中的一对“死对头”——LDL将脂质带到外周组织中,HDL更多是对胆固醇的反向转运,也就是不断将胆固醇从外周组织运输到肝脏。因此,LDL-胆固醇(LDL-C)一直被认为是“坏胆固醇”。

然而,最近发表在《美国心脏病学会杂志》(JACC)上的两项大型研究则激起了大家上述认知的争议:残余胆固醇,而非LDL-C或许才是引起ASCVD的罪魁祸首。残余胆固醇(Remnant-C)被定义为除了LDL-C和HDL-C外,人体内包括VLDL-C与中密度脂蛋白胆固醇(IDL-C)等两种胆固醇的含量。

近期来自美国约翰霍普金斯的专家发表在在《欧洲心脏病杂志》EHJ上的研究更近一步揭示了残余胆固醇对心血管疾病的预测价值。无论LDL-C水平如何,残余胆固醇水平≥24 mg/dL,动脉粥样硬化相关性疾病的发生风险升高。

研究人员汇集了来自社区动脉硬化风险研究(n = 9748)、动脉硬化多种族研究(n = 3049)和年轻人冠状动脉风险发展(n = 4735)的17532名冠心病(ASCVD)的人的数据。将非高密度脂蛋白胆固醇(非HDL-C)减去LDL-C计算得残余胆固醇(RC)。调整后的Cox模型被用来估计与对数RC水平相关的发生ASCVD的风险。此外还进行了不一致分析,利用百分位数单位(>10个单位)和临床相关的LDL-C目标的差异,检查RC与LDL-C不一致/一致组的相对ASCVD风险。

参与者的平均年龄为52.3±17.9岁,56.7%为女性,34%为黑人。在18.7年的中位随访期间,共有2143例ASCVD事件。经过包括LDL-C和apoB在内的多变量调整,对数RC与ASCVD风险增加65%有关[危险比(HR)1.65,95%置信区间(CI)1.45-1.89]。此外,与RC与LDL-C均升高的组相比,高RC/低LDL-C组,而不是低RC/高LDL-C组,与ASCVD风险增加21%有关(HR =1.21,95% CI 1.08-1.34)。在检查不同临床切点的不一致时,也显示了类似的结果。

无论LDL-C水平如何,RC≥24 mg/dL,动脉粥样硬化相关性疾病的发生风险升高

综上,残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。

 

参考文献:

Remnant cholesterol predicts cardiovascular disease beyond LDL and ApoB: a primary prevention study. Eur Heart J. 2021 Jul 19:ehab432. doi:10.1093/eurheartj/ehab432.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1057359, encodeId=334b105e359c8, content=<a href='/topic/show?id=fc78102625d7' target=_blank style='color:#2F92EE;'>#高脂血症#</a>残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102625, encryptionId=fc78102625d7, topicName=高脂血症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 07:44:43 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1253824, encodeId=1ff012538249b, content=<a href='/topic/show?id=658d634305b' target=_blank style='color:#2F92EE;'>#残余胆固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63430, encryptionId=658d634305b, topicName=残余胆固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=shuangle, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422606, encodeId=5e5e142260657, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055228, encodeId=eaca105522883, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Mon Sep 27 07:07:03 CST 2021, time=2021-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055178, encodeId=ad5110551e8f2, content=知道研究研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=df324723890, createdName=452946589, createdTime=Sun Sep 26 22:23:49 CST 2021, time=2021-09-26, status=1, ipAttribution=)]
    2021-10-04 1def6e10m76(暂无匿称)

    #高脂血症#残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1057359, encodeId=334b105e359c8, content=<a href='/topic/show?id=fc78102625d7' target=_blank style='color:#2F92EE;'>#高脂血症#</a>残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102625, encryptionId=fc78102625d7, topicName=高脂血症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 07:44:43 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1253824, encodeId=1ff012538249b, content=<a href='/topic/show?id=658d634305b' target=_blank style='color:#2F92EE;'>#残余胆固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63430, encryptionId=658d634305b, topicName=残余胆固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=shuangle, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422606, encodeId=5e5e142260657, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055228, encodeId=eaca105522883, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Mon Sep 27 07:07:03 CST 2021, time=2021-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055178, encodeId=ad5110551e8f2, content=知道研究研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=df324723890, createdName=452946589, createdTime=Sun Sep 26 22:23:49 CST 2021, time=2021-09-26, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1057359, encodeId=334b105e359c8, content=<a href='/topic/show?id=fc78102625d7' target=_blank style='color:#2F92EE;'>#高脂血症#</a>残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102625, encryptionId=fc78102625d7, topicName=高脂血症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 07:44:43 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1253824, encodeId=1ff012538249b, content=<a href='/topic/show?id=658d634305b' target=_blank style='color:#2F92EE;'>#残余胆固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63430, encryptionId=658d634305b, topicName=残余胆固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=shuangle, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422606, encodeId=5e5e142260657, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055228, encodeId=eaca105522883, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Mon Sep 27 07:07:03 CST 2021, time=2021-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055178, encodeId=ad5110551e8f2, content=知道研究研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=df324723890, createdName=452946589, createdTime=Sun Sep 26 22:23:49 CST 2021, time=2021-09-26, status=1, ipAttribution=)]
    2021-09-28 zhwj
  4. [GetPortalCommentsPageByObjectIdResponse(id=1057359, encodeId=334b105e359c8, content=<a href='/topic/show?id=fc78102625d7' target=_blank style='color:#2F92EE;'>#高脂血症#</a>残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102625, encryptionId=fc78102625d7, topicName=高脂血症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 07:44:43 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1253824, encodeId=1ff012538249b, content=<a href='/topic/show?id=658d634305b' target=_blank style='color:#2F92EE;'>#残余胆固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63430, encryptionId=658d634305b, topicName=残余胆固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=shuangle, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422606, encodeId=5e5e142260657, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055228, encodeId=eaca105522883, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Mon Sep 27 07:07:03 CST 2021, time=2021-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055178, encodeId=ad5110551e8f2, content=知道研究研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=df324723890, createdName=452946589, createdTime=Sun Sep 26 22:23:49 CST 2021, time=2021-09-26, status=1, ipAttribution=)]
    2021-09-27 黄小丫

    学习。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1057359, encodeId=334b105e359c8, content=<a href='/topic/show?id=fc78102625d7' target=_blank style='color:#2F92EE;'>#高脂血症#</a>残余胆固醇或可作为冠心病或中风发生风险的独立预测因子。此外,残余胆固醇检测结果或将有助于判断LDL水平无法反映的潜在心血管疾病。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102625, encryptionId=fc78102625d7, topicName=高脂血症)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 07:44:43 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1253824, encodeId=1ff012538249b, content=<a href='/topic/show?id=658d634305b' target=_blank style='color:#2F92EE;'>#残余胆固醇#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63430, encryptionId=658d634305b, topicName=残余胆固醇)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=shuangle, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422606, encodeId=5e5e142260657, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Tue Sep 28 05:58:47 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055228, encodeId=eaca105522883, content=学习。, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2019/08/05/9b4c18dcaa300d0f1afa44f3307139a0.jpg, createdBy=e8f25148686, createdName=黄小丫, createdTime=Mon Sep 27 07:07:03 CST 2021, time=2021-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1055178, encodeId=ad5110551e8f2, content=知道研究研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=df324723890, createdName=452946589, createdTime=Sun Sep 26 22:23:49 CST 2021, time=2021-09-26, status=1, ipAttribution=)]
    2021-09-26 452946589

    知道研究研究

    0

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上图为研究中涉及到的各因子之间的影响关系,其中1到5皆为研究中需验证的关系 研究要点: 1.非空腹残余胆固醇升高及低密度脂蛋白胆固醇升高皆可引起缺血性心脏疾病。 2.残余胆固醇的升高可以导致伴有低度炎症反应的缺血性心脏疾病,低密度脂蛋白胆固醇引起的缺血性心脏疾病而不引起炎症反应。 已有研究指出,非空腹残余胆固醇升高及低密度脂蛋白胆固醇升高皆可引起缺血性心脏疾病(IHD),而现阶段仍

Clinica Chimica Acta:中国冠心病患者残余胆固醇水平的比较

关于残余胆固醇(RC),尤其是非空腹RC,是否是中国受试者冠心病(CHD)的一个因果危险因素的证据很少。近年来,估计RC水平(RCe)被应用于许多大样本的研究中。本研究旨在比较中国受试者不同方法测定的LDL-C水平计算的空腹和非空腹RCe,并探讨其对冠心病的贡献。

Eur Heart J:残余胆固醇可预测心血管疾病

在无ASCVD的个体中,升高的RC水平与ASCVD相关,且独立于传统的危险因素、LDL-C和apoB水平。

拓展阅读

ISC 2024:残余脂蛋白颗粒胆固醇、极低密度脂蛋白胆固醇与缺血性中风发病风险

在老年人中,RLP-C 和 VLDL-C 与 IS 风险有关,尤其是动脉粥样硬化性 IS。

Cardiovasc Diabetol:残余胆固醇和主动脉瓣钙化进展风险的关系

在无动脉粥样硬化性心血管疾病的受试者中,升高的RC被确定为AVC进展的剩余风险,独立于传统的心血管危险因素。

Eur J Prev Cardiol:残余胆固醇与强化降压对老年高血压患者的影响

尽管目前的指南推荐脂质控制治疗,但仍存在较高的心血管疾病残留风险,残留胆固醇增加了这种残留风险。残留胆固醇是指富含甘油三酯的脂蛋白中的胆固醇含量。在空腹状态下,残留胆固醇包括极低密度脂蛋白胆固醇和中密

ATVB:残余胆固醇对动脉粥样硬化性心血管结局的因果效应

这项大规模孟德尔随机化研究显示,RC和心血管疾病之间存在强大的遗传因果关系。对CAD和MI的影响与LDL胆固醇无关。早期筛查RC和长期抑制RC应该是未来治疗干预的重点。

Stroke:让LDL-C“背锅”的残余胆固醇变异性和缺血性卒中发生密切相关!

残余胆固醇,而非LDL-C或许才是引起ASCVD的罪魁祸首。

Eur Heart J:残余胆固醇可预测心血管疾病

在无ASCVD的个体中,升高的RC水平与ASCVD相关,且独立于传统的危险因素、LDL-C和apoB水平。