累积残余胆固醇暴露对高血压患者心力衰竭的影响

Effect of cumulative remnant cholesterol exposure on heart failure in hypertensive patients

    摘要
  • 摘要:
    目的 探究累积残余胆固醇（cumRC）对高血压患者新发心力衰竭的影响。
    方法 选择连续参加2006、2008、2010年度开滦集团健康体检的无心力衰竭病史的高血压患者27 839例作为观察对象，依据cumRC水平四分位数分为4组：第1四分位组（cumRC＜2.86 mmol/L）（n=6 959）、第2四分位组（cumRC 2.86～＜4.25 mmol/L）（n=6 960）、第3四分位组（cumRC 4.25～＜5.90 mmol/L）（n=6 960）、第4四分位组（cumRC≥5.90 mmol/L）（n=6 960）。计算4组心力衰竭累积发病率。采用多因素Cox回归模型分析cumRC对高血压患者新发心力衰竭的影响。
    结果 在中位随访9.94（9.52，10.26）年间，共有903例（3.24%）心力衰竭发生。Kaplan-Meier曲线显示，第1～4四分位组心力衰竭的累积发病率逐渐升高（Log-rank检验，χ2 =28.96，P＜0.01）。多因素Cox 回归分析结果显示：以第1四分位组为对照，随着cumRC升高，心力衰竭发病风险逐渐增加，第4四分位组风险最高（HR=1.48，95%CI 1.21～1.80，P＜0.01）。以传统危险因素构建风险预测模型，在基本预测模型的基础上分别加入2006年单次残余胆固醇测量值（RC2006）、基线时单次残余胆固醇测量值（RC2010）和cumRC发现，cumRC预测模型C-index为75.09%，与基本预测模型（C-index为74.91%），RC2006预测模型（C-index为74.95%）、RC2010预测模型（C-index为74.91%）相比，C-index分别提升了0.0018、0.0014、0.0018。此外，删除发生心肌梗死、心房颤动者进行敏感性分析显示，cumRC均与新发心力衰竭的发生相关。
    结论 高cumRC与高血压患者心力衰竭的发病风险增加有关，且cumRC对心力衰竭风险的预测能力优于单次残余胆固醇测量值。

     

    Abstract:
    Objective To evaluate the effect of cumulative remnant cholesterol (cumRC) on new-onset heart failure in hypertensive patients.
    Methods A total of 27 839 hypertensive patients who participated in three consecutive health examination of Kailuan Group in 2006, 2008 and 2010 and had no history of heart failure were selected. The patients were divided into 4 groups according to the quartiles of cumRC levels: Q1 (cumRC＜2.86 mmol/L, n=6 959), Q2 (2.86 to ＜4.25 mmol/L, n=6 960), Q3 (4.25 to ＜5.90 mmol/L, n=6 960), Q4 (cumRC≥5.90 mmol/L, n=6 960). The cumulative incidence of heart failure in the 4 groups were calculated. The effect of cumRC on the new onset of heart failure in hypertensive patients was analyzed by multivariate Cox regression model.
    Results During a median follow-up of 9.94 (9.52, 10.26) years, a total of 903 cases (3.24%) developed heart failure. Kaplan-Meier curves showed a progressively higher cumulative incidence of heart failure in quartiles 1 to 4 (Log-rank test, χ2 =28.96, P＜0.01). Multivariate Cox regression analysis showed that the risk of heart failure increased progressively with the increase of cumRC, the HR was the highest in the Q4 group compared with Q1 group (HR=1.48; 95%CI 1.21-1.80). Based on traditional risk factors, single residual cholesterol (RC) in 2006 (RC2006), single RC at baseline (RC2010) and cumRC were added to construct risk prediction models. The results showed that the C-index of cumRC model was 75.09%, improved by 0.0018, 0.0014, and 0.0018, respectively compared with the C-index of the basic prediction model (74.91%), RC2006 prediction model (74.95%), and RC2010 prediction model (74.91%). In addition, sensitivity analysis deleting patients with myocardial infarction and atrial fibrillation showed that cumRC was significantly associated with the occurrence of new-onset heart failure.
    Conclusions High cumRC is associated with an increased risk of developing heart failure in hypertensive patients. The predictive power of cumRC for heart failure risk is better than that of single RC measurement.

     

    • HTML全文
    • 参考文献(27)
    • 相关文章
    • 施引文献
  • 资源附件(0)

/

返回文章
返回