Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study

Wang, Bo1,2; Guo, Zhaodong3,4; Li, Huanqiang1,2; Zhou, Ziyou5; Lu, Hongyu1,2; Ying, Ming1,2; Mai, Ziling5; Yu, Yaren6; Yang, Yongquan1,2; Deng, Jingru1,2; Chen, Jiyan1,2,5,7; Tan, Ning1,2,5,7; Liu, Jin1,2,5,7; Liu, Yong1,2,5,7; Chen, Shiqun1,2,5,7

2022-03-01

10.1016/j.clnu.2022.01.027

CLINICAL NUTRITION   影响因子和分区

0261-5614

1532-1983

Background & aims: Non-high-density lipoprotein cholesterol (non-HDL-C) and low-density lipoprotein cholesterol (LDL-C) were established as the target for blood lipid management among patients with coronary artery disease (CAD). Previous study reported a negative relation between baseline LDL-C levels and long-term prognosis. However, the association between baseline non-HDL-C concentration and clinical outcomes is unknown. Methods: A total of 41,182 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (non-HDLC 2.2 mmol/L, n = 3236; non-HDL-C 2.2 mmol/L, n = 37,946). The Kaplan-Meier method, Cox regression analyses and restricted cubic splines were used to assess the association between non-HDL-C levels and long-term all-cause mortality. Results: The overall mortality was 12.74% (n = 5247) over a median follow-up period of 5.20 years. Kaplan-Meier analysis showed that low non-HDL-C levels were paradoxically associated with a worse prognosis. After adjustment for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low non-HDL-C levels (<2.2 mmol/L) were not significantly associated with all-cause mortality (adjusted HR, 1.03; 95% CI, 0.93-1.14). After adjustment for nutritional status, the risk of all-cause mortality in patients with low non-HDL-C levels decreased (adjusted HR, 0.86; 95% CI, 0.78-0.95). In the final multivariate Cox model adjusting for full covariates, low non-HDL-C level was related to better prognosis (adjusted HR, 0.88; 95% CI, 0.80-0.98). Conclusion: This study found a paradoxical association between baseline non-HDL-C concentration and long-term all-cause mortality. Malnutrition mainly mediates to the non-HDL-C paradox. Elevated nonHDL-C concentration is still a risk factor of long-term all-cause mortality after considering nutritional status. (c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Non-high-density lipoprotein cholesterol Coronary artery disease Long -term all-cause mortality Paradox Malnutrition

SCI

英语

其他

Beijing Lisheng Cardiovascular Health Foundation[LHJJ20141751] ; National Natural Science Foundation of China[81670339,81970311] ; Guangdong Provincial People's Hospital Dengfeng Project Fund["DFJH201919","DFJH2020026"]

Nutrition & Dietetics

Nutrition & Dietetics

WOS:000767352400016

CHURCHILL LIVINGSTONE

CLINICAL MEDICINE

Web of Science

1.Guangdong Acad Med Sci, Dept Cardiol, Guangdong Cardiovasc Inst, Guangdong Prov Peoples Hosp, Guangzhou 510080, Peoples R China
2.Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Guangdong Prov Key Lab Coronary Heart Dis Prevent, Guangdong Cardiovasc Inst, Guangzhou 510080, Peoples R China
3.Jinan Univ, Dept Cardiol, Shenzhen Peoples Hosp, Clin Med Coll 2, Shenzhen 518020, Guangdong, Peoples R China
4.Southern Univ Sci & Technol, Affiliated Hosp 1, Shenzhen 518020, Peoples R China
5.South China Univ Technol, Guangdong Prov Peoples Hosp, Sch Med, Guangzhou 510100, Peoples R China
6.First Peoples Hosp Foshan, Dept Cardiol, 81 Lingnan Rd, Foshan 528000, Peoples R China
7.Southern Med Univ, Sch Clin Med 2, Guangzhou 510515, Peoples R China

Wang, Bo,Guo, Zhaodong,Li, Huanqiang,et al. Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study[J]. CLINICAL NUTRITION,2022,41(3).

Wang, Bo.,Guo, Zhaodong.,Li, Huanqiang.,Zhou, Ziyou.,Lu, Hongyu.,...&Chen, Shiqun.(2022).Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study.CLINICAL NUTRITION,41(3).

Wang, Bo,et al."Non-HDL cholesterol paradox and effect of underlying malnutrition in patients with coronary artery disease: A 41,182 cohort study".CLINICAL NUTRITION 41.3(2022).