| Objectives: Atherosclerotic cardiovascular disease(ASCVD)is one of the most arteriosclerosis diseases in the world.The high level of Low-density lipoprotein cholesterol(LDL-C)is considered to be a key risk factor for the Low-density lipoprotein of ASCVD.However,a large number of clinical studies have shown that LDL-C in some patients with coronary heart disease is at a low level,suggesting that LDL-C has limitations in the prevention and control of ASCVD risk.The purpose of this study is to explore the predictive values of baseline fasting non-traditional lipid indexes for the severity and morbidity of coronary heart disease in people with Low-density lipoprotein less than 1.8 mmol/L.Methods: From January 2012 to November 2022,a total of 302 Low-density lipoprotein less than 1.8 mmol/L patients who had undergone coronary angiography in the Cardiology department of Shengjing Hospital of China Medical University and had not taken lipid lowering drugs previously were enrolled in this observation study.Traditional risk factors for coronary heart disease and baseline fasting lipid levels were collected in all patients including low density lipoprotein cholesterol(LDL-C)and other non-traditional lipid indexes such as apolipoprotein A1(apoA1),apolipoprotein B(apoB)and the calculated levels of non high density lipoprotein-cholesterol(non-HDL-C),remnant lipoprotein cholesterol(RLP-C)and apoB/apoA1 ratio.The patients were divided into coronary heart disease(CHD)group and non-coronary heart disease(non-CHD)group.The Gensini System(GS)score was used to evaluate the severity of coronary atherosclerosis.Furthermore,the GS score > 0 group was divided into three groups based on trichotomy: low-risk group,medium-risk group and high-risk group.Kruskal-wallis H test was used to analyze the difference of LDL-C and non-traditional lipid indexes between CHD group and non-CHD group,and among each GS group.The influences of lipid indexes on the risk of CHD were evaluated by binary logistic regression analysis,Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlations between serum lipid levels and GS scores.Results: A total of 302 patients with serum Low-density lipoprotein levels below 1.8mmol/L were included in this study,patients in the CHD group were older(61.35±9.66 vs 57.15±12.48 years,P = 0.003),male(70.9 vs 46.7%,P<0.001),smoking(54.6 vs 26.7%,P<0.001),diabetes(37.0 vs 24.0%,P = 0.039)and higher Hb A1c(6.33±1.12 vs 5.89±1.39%,P = 0.013),the percentage of insulin use was higher in CHD group(12.4 vs 4.0%,P = 0.039).In addition,the percentage of peripheral white blood cells(WBC)in CHD group was significantly higher than that in non-CHD group(6.75±1.98 vs 6.21±1.65,P = 0.035).Compared with the non-CHD group,the levels of RLP-C(0.57±0.36 vs 0.49±0.27 mmol/l,P = 0.036),apob(0.65±0.26 vs 0.56±0.11 g/L,P = 0.003)and apoB/apoA1(0.62±0.27 vs0.50.0.17,P = 0.001)were higher in patients with CHD,HDL-C(0.96±0.29 vs1.08±0.33 mmol/l,P = 0.003)and apoA1(1.1.09±0.22 vs 1.17±0.24 g/l,P = 0.011)were lower,but TG,non-HDL-C,TC and LDL-C had no significant difference between the two groups.In binary logistic regression analysis,older,male,diabetes,smoking and higher Hb A1 c increased the risk of CHD by 1.039,2.788,1.860,3.311 and 1.490 times,respectively,the increase of HDL-C(or = 0.300,P = 0.004)and apoA1(or = 0.234,P = 0.013)in blood lipids significantly reduced the risk of coronary heart disease,high levels of apoB,apoB/apoA1,RLP-C(or = 2.484,P =0.017)and WBC(or = 1.174,P = 0.036)all contributed significantly to the risk of CHD,especially apoB and apoB/apoA1,each 1-unit increase in apoB was associated with a 16.719-fold increase in the risk of coronary heart disease(P = 0.006),and each1-unit increase in apoB/apoA1 was associated with a 13.314-fold increase in the risk of coronary heart disease(P = 0.001).In terms of severity of coronary artery disease,the patients with higher GS score were older(58.63±10.75 vs 61.68±9.30 vs64.43±9.55,P = 0.001)and had higher WBC(6.29±1.69 vs 6.79±1.96 vs 7.13±2.13× 109/l,P = 0.022),smoking(41.9 vs 51.5 vs 66.7%,P = 0.008)and diabetes mellitus(30.1 vs 35.1 vs 43.5%,P = 0.021)were more common,but there was no significant difference in sex,hypertension and family history,there was a trend of increase in BMI(22.55±3.80 vs 24.28±3.30 vs 24.75±3.84 kg/m2,P = 0.051),non-HDL-C(1.98±0.31 vs 2.04±0.51 vs 2.08±0.43 mmol/l,P = 0.048),apob(0.58±0.11 vs 0.59±0.16 vs 0.79±0.39 mmol/l,P < 0.001)and apoB/apoA1 ratio(0.54±0.17 vs 0.56±0.17 vs 0.77±0.39,P<0.001)were significantly increased in the patients with higher GS scores,the levels of apoA1 were significantly decreased,but the levels of TG,TC,HDL-C,LDL-C and RLP-C were not significantly different between groups.Spearman correlation analysis was used to examine the correlation between each variable and the severity of coronary atherosclerosis,age(r = 0.213,P =0.001),smoking(r = 0.234,P<0.001)were positively correlated with the severity of coronary artery disease,while apoA1(R =-0.123,P = 0.048)was negatively correlated with GS,non-HDL-C(r = 0.083,P = 0.018),apoB/apoA1 ratio(r = 0.249,P<0.001),apob(r = 0.179,P = 0.004)were positively correlated with GS score.Among other risk indexes,WBC(r = 0.184,P = 0.003)was positively correlated with GS score.Multiple linear regression analysis showed that age(β= 0.219,P<0.001)and smoking(β= 0.201,P = 0.001)were positively correlated with the severity of coronary artery disease The ratio of apoB/apoA1(β= 0.466,P<0.001),apoB(β=0.502,P<0.001)and non-HDL-C(β= 0.075,P = 0.023)were positively correlated with the severity of coronary artery disease,WBC(β = 0.139,P = 0.026)was positively correlated with GS score.The multivariate linear equation GS integral =0.219 × age + 0.201 × smoking + 0.139 × WBC + 0.502 × apoB + 0.466 ×apoB/apoA1 + 0.075×non-HDL-C + 0.519 was obtained.Conclusions: For the Chinese people whose LDL-C level is lower than 1.8 mmol/L at baseline,we should pay more attention to the status of traditional risk factors in the incidence and severity of coronary heart disease,and more attention should be paid to the fasting non-traditional blood lipid indexes,in particular,the value of APOB and APOB/APOA1 ratio in predicting the risk of coronary heart disease and the severity of coronary artery disease was evaluated. |
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