Objective: To explore the predictive value of serum low-density lipoprotein cholesterol/residual cholesterol (LDL-C/RC) coordination on major adverse cardiovascular events (MACE) in elderly hypertensive patients. Methods: This is a prospective cohort study. Elderly hypertensive patients hospitalized in Beijing Anzhen Hospital from June 2018 to June 2020 were prospectively enrolled. According to the coordination of baseline LDL-C/RC, patients were divided into four groups: low LDL-C and low RC (LDL-C<2.6 mmol/L, and RC<0.62 mmol/L), low LDL-C and high RC (LDL-C<2.6 mmol/L, and RC≥0.62 mmol/L), high LDL-C and low RC (LDL-C≥2.6 mmol/L, and RC<0.62 mmol/L), and high LDL-C and high RC (LDL-C≥2.6 mmol/L, and RC≥0.62 mmol/L). Patients were followed up until June 2022. The primary outcome was MACE, including non-fatal acute coronary syndrome, non-fatal acute heart failure, non-fatal stroke and death. Kaplan-Meier survival analysis was used to evaluate MACE among the four groups, and Cox regression analysis was performed to evaluate the related factors of MACE. Results: A total of 847 hypertensive patients were enrolled. There were 453 males (53.5%), mean age was (72.4±8.8) years. There were 207, 162, 263, 215 patients in the low LDL-C and low RC, low LDL-C and high RC, high LDL-C and low RC and high LDL-C and high RC group, respectively. During a median follow-up of 37 months, 196 patients (23.1%) had MACE, including 77 cases (9.1%) of ACS, 56 cases (6.6%) of acute heart failure, 34 cases (4.0%)of non-fatal stroke, 29 cases(3.4%) of all-cause mortality, and 16 cases (1.9%) of cardiovascular death. Risk of MACE of the four groups was significantly different (log-rank P<0.001). Compared with low LDL-C and low RC groups, high LDL-C and high RC groups had the highest incidence of MACE (HR=2.237, 95%CI 1.328-3.783, P=0.004), followed by low LDL-C and high RC groups (HR=1.745, 95%CI 1.220-2.527, P=0.003) and high LDL-C and low RC groups (HR=1.393, 95%CI1.048-1.774, P=0.022). In addition, the risk of nonfatal ACS among the four groups was also statistically significant (P=0.037), while the risk of nonfatal acute heart failure, nonfatal stroke, all-cause mortality and cardiovascular death were similar (all P>0.05). Multivariate Cox regression analysis showed that age (HR=1.271), duration of hypertension (HR=1.339), diabetes (HR=1.415), hyperlipidemia (HR=1.348), serum creatinine (HR=1.263), N-terminal pro-B-type natriuretic peptide (HR=1.316), LDL-C (HR=1.205), RC (HR=1.302), low LDL-C and high RC (HR=1.745), high LDL-C and low RC (HR=1.393), high LDL-C and high RC (HR=2.237) were independently associated with the occurrence of MACE. Conclusion: The coordination of LDL-C/RC affects the risk of MACE in elderly hypertensive patients, and the risk of MACE is the highest in patients with high LDL-C and high RC.
目的： 探索血清低密度脂蛋白胆固醇（LDL-C）/残余胆固醇（RC）协调性对老年高血压患者主要不良心血管事件（MACE）的预测价值。 方法： 本研究为前瞻性队列研究。连续选取2018年6月至2020年6月在北京安贞医院住院的老年高血压患者。依照基线LDL-C/RC的协调性分为4个组，包括低LDL-C和低RC组（LDL-C<2.6 mmol/L，且RC<0.62 mmol/L）、低LDL-C和高RC组（LDL-C<2.6 mmol/L，且RC≥0.62 mmol/L）、高LDL-C和低RC组（LDL-C≥2.6 mmol/L，且RC<0.62 mmol/L）和高LDL-C和高RC组（LDL-C≥2.6 mmol/L，且RC≥0.62 mmol/L）。随访截至2022年6月，主要研究终点为MACE，包括非致死性急性冠脉综合征（ACS）、非致死性急性心力衰竭、非致死性卒中和死亡。采用Kaplan-Meier法评估4组的MACE发生率，多因素Cox回归分析评估MACE的相关因素。 结果： 共纳入847例老年高血压患者，其中男性453例（53.5%），年龄（72.4±8.8）岁。低LDL-C和低RC组、低LDL-C和高RC组、高LDL-C和低RC组、高LDL-C和高RC组分别有207、162、263、215例。中位随访时间37个月，发生196例（23.1%）MACE，包括77例（9.1%）ACS，56例（6.6%）急性心力衰竭，34例（4.0%）卒中，29例（3.4%）全因死亡，16例（1.9%）心血管死亡。4组间比较MACE发生率差异有统计学意义（log-rank P<0.001）。高LDL-C和高RC组的MACE发生风险最高（HR=2.237，95%CI 1.328~3.783，P=0.004），其次为低LDL-C和高RC组（HR=1.745，95%CI 1.220~2.527，P=0.003）和高LDL-C和低RC组（HR=1.393，95%CI 1.048~1.774，P=0.022）。此外，4组间的非致死性ACS发生风险差异也有统计学意义（P=0.037），而急性心力衰竭、卒中、全因死亡和心血管死亡的发生率，4组间比较差异均无统计学意义（P均>0.05）。多因素Cox回归分析结果显示，年龄（HR=1.271）、高血压病程（HR=1.339）、糖尿病（HR=1.415）、高血脂（HR=1.348）、血肌酐（HR=1.263）、N末端B型利钠肽原（HR=1.316）、LDL-C（HR=1.205）、RC（HR=1.302）、低LDL-C和高RC（HR=1.745）、高LDL-C和低RC（HR=1.393）、高LDL-C和高RC（HR=2.237）均与发生MACE独立相关。 结论： LDL-C/RC的协调性影响老年高血压患者发生MACE风险，其中合并高LDL-C和高RC患者的MACE发生风险最高。.