总胆固醇/高密度脂蛋白胆固醇比值及残余胆固醇与冠状动脉钙化的关联

Association of Total Cholesterol/High-Density Lipoprotein Cholesterol Ratio and Remnant Cholesterol with Coronary Artery Calcification

目的探讨总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)比值及残余胆固醇(RC)与冠状动脉钙化评分(CACS)的关系及意义。方法在这项横断面研究中,使用64排螺旋CT采集了河北冀东队列2868名社区人群的冠状动脉造影数据。将每个解剖部位包括左主干(LM)、左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)和主动脉(AO)的单个病变评分相加确定总钙化评分。根据Agatston评分对冠状动脉钙化(CAC)情况进行评分,并根据CAC不存在(CACS=0分)和存在(CACS>0分)将研究对象分为2组,计算并比较2组血脂指标;进一步根据CAC严重程度(无、轻度、中度或重度钙化)分为4组,分析TC/HDL-C比值及RC与CAC严重程度的关联。结果校正混杂因素后,TC/HDL-C比值及RC水平升高与LAD、AO及总CACS升高显著相关。分层分析显示,TC/HDL-C比值与CAC的正相关性在女性LAD更为显著。此外,按TC/HDL-C比值四分位数分组,随着TC/HDL-C比值升高,LAD、AO及总体CAC风险逐步增加,第4四分位数组CAC风险分别是第1四分位数组的1.84倍、2.15倍和2.18倍。TC/HDL-C比值及RC水平也与CAC严重程度呈正相关,随着TC/HDL比值与RC水平的升高,CAC逐步加重。结论TC/HDL-C比值及RC水平升高与多部位CAC相关,可能是CAC的独立危险因素。

Objective To investigate the relationship and significance of the ratio of total cholesterol(TC)to high-density lipoprotein cholesterol(HDL-C)and remnant cholesterol(RC)with coronary artery calcium score(CACS).Methods In this cross-sectional study,coronary angiographic data were acquired using 64-row spiral CT in a community-based population of 2868 individuals from the Hebei Jidong cohort.The total calcification score was determined by summing the individual lesion scores for each anatomical site:left main artery(LM),left anterior descending artery(LAD),left circumflex artery(LCX),right coronary artery(RCA),and aorta(AO).The amount of calcium present in the coronary arteries was scored according to the Agatston score,and participants were divided into two groups based on the absence(CACS=0)or presence(CACS>0)of CAC,and lipid indices were calculated and compared between the two groups;they were further classified into four groups according to the severity of CAC(no,mild,moderate,or severe calcification),and the TC/HDL-C ratio as well as RC were analyzed association of both with the severity of CAC.Results After adjusting for confounders,elevated TC/HDL-C ratio and RC levels were significantly associated with elevated LAD,AO,and total CACS.Stratified analyses showed that the positive correlation between TC/HDL-C ratio and CAC was more significant in the LAD of women.Additionally,grouped by TC/HDL-C ratio quartiles,the risk of positive LAD,AO,and total CAC scores increased progressively with higher TC/HDL ratios,with the highest quartile group being 1.84,2.15,and 2.18 times higher than the lowest quartile group,respectively.TC/HDL-C ratio and RC levels were also positively correlated with CAC severity.The TC/HDL-C ratio and RC levels were also positively correlated with CAC severity,which progressively worsened with increasing TC/HDL-C ratio and RC levels.Conclusion Elevated TC/HDL-C ratio as well as RC levels are associated with multisite CAC,and they may be independent risk factors for CAC.