科研之友
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摘要
Background: Low-density lipoprotein cholesterol(LDL-C) is one of the important risk factors for coronary heart disease(CHD).Most international guidelines consistently recommend LDL-C as the main treatment target for patients with hypercholesterolemia.However,whether LDL-C and non-high-density lipoprotein cholesterol(non-HDL-C)should be used simultaneously as indicators of secondary prevention of cardiovascular diseases is still controversial at home and abroad.Objective To investigate the relationship between goal attainment of non-HDL-C and recurrence of adverse cardiovascular events in patients with CHD after percutaneous coronary intervention(PCI),and to compare the predictive value of the goal attainment of non-HDL-C and LDL-C in the long-term prognosis of patients with CHD.Methods: A total of 665 patients who underwent PCI for CHD from 2002 to 2008 were followed up for three years in April 2019.The patients were divided into groups according to the goal attainment of blood lipid indicators(non-HDL-C,LDL-C) after six months of secondary prevention.Kaplan-Meier survival curve,Log-Rank test and Cox proportional hazards regression model were used to analyze the relationship between goal attainment of blood lipid indicators and major adverse cardiovascular events(MACE).Results: In the real world,a relatively small number of CHD patients could meet the standard of blood lipid indicators after six months of secondary prevention after PCI.25.71%(171/665) and 27.07%(180/665) of patients met the criteria recommended in the guidelines for LDL-C and non-HDL-C,and only 17.29%(115/665) of patients met the criteria of both LDL-C and non-HDL-C at the same time.The incidence of MACE was 32.7%(56/171) in LDL-C standard group and 35.8%(177/494) in LDL-C non-standard group.The incidence of MACE was 25.6%(46/180) in non-HDL-C standard group and 38.6%(187/485) in non-HDL-C non-standard group.There was no significant difference in risk curve between the LDL-C standard group and the non-standard group(P=0.545);the cumulative incidence rate of MACE in the non-HDL-C standard group was significantly lower than that in the non-HDL-C non-standard group(P=0.010);there was no significant difference between the only non-HDL-C standard group and only LDL-C standard group(P=0.127).After adjusting the traditional risk factors such as age,gender,BMI,smoking history,coronary heart disease type and comorbidity by Cox proportional risk regression analysis,it was found that compared with LDL-C standard group,HR of LDL-C non-standard group was 1.16〔95%CI(0.83,1.61),P = 0.386〕;compared with non-HDL-C standard group,non-HDL-C non-standard group had higher risk of mace in the long term,HR was 1.61〔95%CI(1.12,2.30),P=0.009〕.Conclusion: Non-HDL-C goal attainment is significantly associated with long-term MACE of CHD patients after PCI,while LDL-C has nothing to do with this.Therefore,non-HDL-C may be a more suitable monitoring indicator for dyslipidemia therapy in CHD patients after PCI than LDL-C.
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