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

作者：Wang, Bo; Guo, Zhaodong; Li, Huanqiang; Zhou, Ziyou; Lu, Hongyu; Ying, Ming; Mai, Ziling; Yu, Yaren; Yang, Yongquan; Deng, Jingru; Chen, Jiyan; Tan, Ning; Liu, Jin^*; Liu, Yong^*; Chen, Shiqun^*

来源：CLINICAL NUTRITION, 2022, 41(3): 723-730.

DOI：10.1016/j.clnu.2022.01.027

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

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.

• 单位
  广东省人民医院; y; 1; 广东省心血管病研究所; 南方医科大学; 佛山市第一人民医院