高血压合并冠心病患者游离脂肪酸水平与不良结局的 U 型关系：一项大型前瞻性队列研究的证据。

The U -shape relationship between free fatty acid level and adverse outcomes in coronary artery disease patients with hypertension: evidence from a large prospective cohort study.

机构信息

Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, No. 137, Liyushan Road, Urumqi, 830054, China.

Key Laboratory of High Incidence Disease Research in Xingjiang, (Xinjiang Medical University, Ministry of Education), Urumqi, China.

出版信息

Lipids Health Dis. 2024 Sep 10;23(1):291. doi: 10.1186/s12944-024-02273-z.

DOI:10.1186/s12944-024-02273-z

PMID:39256835

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11386348/

Abstract

BACKGROUND

Evidence is scarce on the effect of free fatty acid (FFA) level in the prognosis of coronary artery disease (CAD) patients with hypertension. This study.

METHODS

A large prospective cohort study with a follow-up period of average 2 years was conducted at Xinjiang Medical University Affiliated First Hospital from December 2016 to October 2021. A total of 10,395 CAD participants were divided into groups based on FFA concentration and hypertension status, and then primary outcome mortality and secondary endpoint ischemic events were assessed in the different groups.

RESULTS

A total of 222 all-cause mortality (ACMs), 164 cardiac mortality (CMs), 718 major adverse cardiovascular events (MACEs) and 803 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during follow-up period. A nonlinear relationship between FFA and adverse outcomes was observed only in CAD patients with hypertension. Namely, a "U -shape" relationship between FFA levels and long-term outcomes was found in CAD patients with hypertension. Lower FFA level (< 310 µmol/L), or higher FFA level (≥ 580 µmol/L) at baseline is independent risk factors for adverse outcomes. After adjustment for confounders, excess FFA increases mortality (ACM, HR = 1.957, 95%CI(1.240-3.087), P = 0.004; CM, HR = 2.704, 95%CI(1.495-4.890, P = 0.001) and MACE (HR = 1.411, 95%CI(1.077-1.848), P = 0.012), MACCE (HR = 1.299, 95%CI (1.013-1.666), P = 0.040) prevalence. Low levels of FFA at baseline can also increase the incidence of MACE (HR = 1.567,95%CI (1.187-2.069), P = 0.002) and MACCE (HR = 1.387, 95%CI (1.070-1.798), P = 0.013).

CONCLUSIONS

Baseline FFA concentrations significantly associated with long-term mortality and ischemic events could be a better and novel risk biomarker for prognosis prediction in CAD patients with hypertension.

TRIAL REGISTRATION

The details of the design were registered on https://www.chictr.org.cn/ (Identifier NCT05174143).

摘要

背景

游离脂肪酸（FFA）水平在高血压合并冠心病（CAD）患者预后中的作用证据有限。本研究。

方法

2016 年 12 月至 2021 年 10 月，在新疆医科大学第一附属医院进行了一项大型前瞻性队列研究，平均随访时间为 2 年。根据 FFA 浓度和高血压状态将 10395 例 CAD 患者分为不同组，然后评估不同组的主要终点死亡率和次要终点缺血事件。

结果

随访期间共记录 222 例全因死亡率（ACMs）、164 例心源性死亡率（CMs）、718 例主要不良心血管事件（MACEs）和 803 例主要不良心血管和脑血管事件（MACCEs）。仅在高血压合并 CAD 患者中观察到 FFA 与不良结局之间存在非线性关系。即，高血压合并 CAD 患者的 FFA 水平与长期结局之间存在“U 型”关系。基线时较低的 FFA 水平（<310 μmol/L）或较高的 FFA 水平（≥580 μmol/L）是不良结局的独立危险因素。在调整混杂因素后，过量的 FFA 会增加死亡率（ACM，HR=1.957，95%CI（1.240-3.087），P=0.004；CM，HR=2.704，95%CI（1.495-4.890，P=0.001）和 MACE（HR=1.411，95%CI（1.077-1.848），P=0.012），MACCE（HR=1.299，95%CI（1.013-1.666），P=0.040）患病率。基线时较低的 FFA 水平也会增加 MACE（HR=1.567，95%CI（1.187-2.069），P=0.002）和 MACCE（HR=1.387，95%CI（1.070-1.798），P=0.013）的发生率。