血浆残余胆固醇水平与更年期女性冠心病的相关性

The association between plasma remnant cholesterol level and coronary artery disease in menopausal women

摘要:

目的]探讨血浆残余胆固醇(RC)水平与更年期女性冠心病(CAD)的相关性及其临床价值。 [方法]回顾性纳入2020年1月—2023年12月于昌吉回族自治州人民医院行冠状动脉造影的654例更年期女性,根据造影结果分为CAD组(n＝476)与非CAD组(n＝178)；以RC水平中位数(0.37 mmol/L)为界值进行分组,采用多因素Logistic回归分析探究RC水平与CAD的关联,通过ROC曲线评估其预测效能,并进行亚组分析及交互作用检验。 [结果]CAD组RC水平显著高于非CAD组(P＜0.001),校正传统危险因素后,高RC水平仍是CAD的独立危险因素(OR＝1.884,95%CI:1.081～3.285,P＝0.025)。RC水平、2型糖尿病、高血压单项指标的AUC值分别为0.556、0.572、0.602；将三者联合分析时,AUC值提升至0.654(95%CI:0.608～0.700,P＜0.001)。RC水平与脂蛋白(a)水平(≥300 mg/L)存在显著交互作用(P＜0.05),高RC＋高脂蛋白(a)亚组风险较高；在低密度脂蛋白胆固醇(LDLC)≥2.6 mmol/L、他汀治疗亚组中,RC水平显著升高(均P＜0.05)。 [结论]高RC水平是更年期女性CAD的独立危险因素,与脂蛋白(a)存在协同致病效应。RC水平联合2型糖尿病和高血压可优化更年期女性CAD风险预测,为实现该群体的危险再分层提供了新思路。

Abstract:

Aim To investigate the association between plasma remnant cholesterol (RC) level and coronary artery disease (CAD) in menopausal women and evaluate its clinical value. Methods In this retrospective study, 654 menopausal women who underwent coronary angiography at Changji Hui Autonomous Prefecture People's Hospital between January 2020 and December 2023 were included. Based on angiographic findings, participants were categorized into CAD group (n＝476) and non-CAD group (n＝178). Participants were stratified using the median RC level (0.37 mmol/L) as the cut-off value. Multivariable Logistic regression was used to assess the relationship between RC level and CAD, and ROC curves were generated to evaluate predictive performance. Subgroup analyses were conducted to test for interaction effects. Results RC levels were significantly higher in the CAD group compared with the non-CAD group (P＜0.001). After adjustment for conventional risk factors, high RC levels remain an independent risk factor for CAD (OR＝1.4,5%CI:1.081～3.285, P＝0.025). The individual AUC values of RC level, type 2 diabetes and hypertension were 0.6,0.572 and 0.602 respectively. When the three were analyzed together, the AUC value increased to 0.654 (95%CI:0.608～0.700, P＜0.001). A significant interaction was observed between RC level and lipoprotein(a) (≥300 mg/L) (P_for interaction＜0.05), with the highest CAD risk identified in the subgroup with high RC and high lipoprotein(a).Moreover, RC levels were significantly elevated in patients with low density lipoprotein cholesterol (LDLC)≥2.6 mmol/L and in those receiving statin therapy (both P＜0.05). Conclusions High RC levels are an independent risk factor for CAD in menopausal women and exhibit a synergistic effect with lipoprotein(a). Integrating RC level with type 2 diabetes and hypertension improves CAD risk prediction in this population, suggesting a potential strategy for refined risk stratification.