血清尿酸/高密度脂蛋白胆固醇比值累积暴露对新发动脉粥样硬化性心血管疾病的影响

Association between the cumulative exposure of serum uric acid to high-density lipoprotein cholesterol ratio and risk of atherosclerotic cardiovascular disease

    摘要
  • 摘要:
    目的 探讨血清尿酸/高密度脂蛋白胆固醇比值累积暴露（cumUHR）对新发动脉粥样硬化性心血管疾病（ASCVD）的影响。
    方法 本研究采用前瞻性研究队列数据库进行回顾性分析，选取连续完成2006、2008、2010年度体检的52 865名开滦集团职工为研究对象。根据cumUHR水平进行四分位数分组，利用Kaplan-Meier法计算各组新发ASCVD的累积发生率。构建多因素Cox回归模型分析cumUHR水平对新发ASCVD的影响，采用4节点限制性立方样条图探讨其剂量-反应关系。
    结果 中位随访时间为11.95年，共新发ASCVD 4 773例（9.03%）。校正包括基线血清尿酸/高密度脂蛋白胆固醇比值（UHR）值在内的混杂因素后，Cox比例风险模型显示，与cumUHR第1四分位组相比，第4四分位组发生ASCVD的风险增加19.4%（HR = 1.194，95%CI：1.074～1.328）。亚型分析显示，cumUHR与心力衰竭和心肌梗死存在关联（P＜0.05），而未发现与缺血性脑卒中风险相关（P＞0.05）。亚组分析显示：在男女性人群中，cumUHR与ASCVD发病风险均存在关联，但在女性人群中尤为突出；仅在非肥胖（BMI＜28 kg/m2）人群、非糖尿病人群和年龄 ≥ 60岁人群中发现cumUHR与ASCVD风险增加相关。限制性立方样条模型表明，cumUHR水平与ASCVD发病风险呈线性剂量反应关系（P总体 = 0.011，P非线性 = 0.823）。
    结论  cumUHR是新发ASCVD的危险因素，与ASCVD发病风险存在线性剂量-反应关系，且这种风险关联存在器官特异性。此外还发现，性别、年龄及糖尿病和肥胖状况影响了cumUHR与ASCVD发病风险的关联。

     

    Abstract:
    Objective To investigate the impact of cumulative exposure of the serum uric acid to high-density lipoprotein cholesterol ratio (cumUHR) on the incidence of new-onset atherosclerotic cardiovascular disease (ASCVD).
    Methods This study conducted a retrospective analysis using a prospective cohort database, selecting 52 865 employees of the Kailuan Group who underwent consecutive physical examinations in 2006, 2008, and 2010 as the study subjects. Based on the quartile levels of cumUHR, the participants were divided into 4 groups. The Kaplan-Meier method was used to calculate the cumulative incidence of new-onset ASCVD in each group. A multivariate Cox regression model was constructed to analyze the impact of cumUHR levels on new-onset ASCVD, and a restricted cubic spline plot with 4 knots was utilized to explore the dose-response relationship.
    Results The median follow-up time was 11.95 years, during which 4 773 new cases of ASCVD (9.03%) were recorded. After adjusting for confounding factors including baseline serum uric acid to high-density lipoprotein cholesterol ratio (UHR) values, the Cox proportional hazards model revealed that compared with the first quartile group of cumUHR, the fourth quartile group had a 19.4% increased risk of ASCVD (HR = 1.194, 95%CI: 1.074–1.328). Subtype analysis revealed that cumUHR was associated with heart failure and myocardial infarction (P＜0.05), while no associated with ischemic stroke (P＞0.05). Subgroup analysis showed that cumUHR was associated with ASCVD risk in both male and female populations, but particularly prominent in females. Increased ASCVD risk was observed only in non-obese (BMI＜28 kg/m2) individuals, non-diabetic individuals, and those aged ≥ 60 years. The restricted cubic spline model indicated a linear dose-response relationship between cumUHR levels and the risk of ASCVD incidence (Poverall = 0.011, Pnon-linear = 0.823).
    Conclusions cumUHR is a risk factor for incident ASCVD, exhibiting a linear dose-response relationship with the risk of ASCVD onset. This risk association demonstrates organ specificity. Sex, age, as well as diabetes and obesity status may impact the relationship between cumUHR and the risk of ASCVD.

     

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