新疆南疆地区维吾尔族人群LDL-C累积暴露对心血管病影响的队列研究

程静; 马儒林; 何佳; 芮东升; 李毓; 张向辉; 简乐瑶; 李嘉航; 郭淑霞; 郭恒

doi:10.16462/j.cnki.zhjbkz.2024.07.005

新疆南疆地区维吾尔族人群LDL-C累积暴露对心血管病影响的队列研究

doi: 10.16462/j.cnki.zhjbkz.2024.07.005

程静^{1, 2},
马儒林¹,
何佳¹,
芮东升¹,
李毓¹,
张向辉¹,
简乐瑶¹,
李嘉航¹,
郭淑霞^{1, 2},
郭恒^{1, 2, ,}

1.
石河子大学医学院预防医学系，石河子 832000
2.
重要新发传染病防控与公共卫生安全兵团重点实验室，石河子 832000

基金项目:

新疆生产建设兵团重点领域科技攻关计划 2021AB030

天山英才科技创新团队：中亚地区高发疾病防治应用研究创新团队 2023TSYCTD0020

详细信息

通讯作者:
郭恒，E-mail: guoheng@shzu.edu.cn

中图分类号: R195.1;R714.252
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- 被引次数: 0
出版历程
- 收稿日期: 2023-08-16
- 修回日期: 2024-04-18
- 网络出版日期: 2024-08-19
- 刊出日期: 2024-07-10

A cohort study of the effect of cumulative exposure to LDL-C on cardiovascular disease among the uyghur population in southern Xinjiang

CHENG Jing^{1, 2},
MA Rulin¹,
HE Jia¹,
RUI Dongsheng¹,
LI Yu¹,
ZHANG Xianghui¹,
JIAN Leyao¹,
LI Jiahang¹,
GUO Shuxia^{1, 2},
GUO Heng^{1, 2
, ,}

1.
Department of Preventive Medicine, Shihezi University School of Medicine, Shihezi 832000, China
2.
Key Laboratory for Prevention and Control of Emerging Infectious Diseases and Public Health Security, the Xinjiang Production and Construction Corps, Shihezi 832000, China

Funds:

The Science and Technology Project of Xinjiang Production and Construction Corps 2021AB030

Tianshan Young Talent Scientific and Technological Innovation Team: Innovative Team for Research on Prevention and Treatment of High-incidence Disease in Central Asia 2023TSYCTD0020

More Information

Corresponding author: GUO Heng，E-mail: guoheng@shzu.edu.cn

摘要

摘要: 目的探讨新疆维吾尔自治区(简称新疆)南疆维吾尔族人群中低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)累积暴露对心血管病(cardiovascular diseases, CVD)的影响。方法研究队列来自新疆生产建设兵团第三师五十一团，纳入在2016-2022年调查期间有3次LDL-C测量值，且相邻两次测量时间间隔≥2年的2 950名维吾尔族人群作为研究对象。使用每个时间间隔LDL-C测量值的加权和(值×时间)计算LDL-C累积暴露(cumulative low density lipoprotein cholesterol, cumLDL-C)。按cumLDL-C三分位数分组，采用Log-rank检验比较各组CVD累积发病率的差异; 使用Cox比例风险回归模型分析cumLDL-C对发生CVD的影响。结果随访期间共新发CVD事件322例(10.92%)，cumLDL-C第一、二、三分位组CVD累积发病率分别为7.12%、11.08%、14.55%，经Log-rank检验，差异有统计学意义($ \begin{equation}\chi^2\end{equation}$=27.440, P ＜ 0.001)。Cox比例风险回归模型显示，校正多种混杂因素后，与cumLDL-C第一分位组相比，cumLDL-C第三分位组发生CVD的HR=1.51(95% CI: 1.12~2.06);cumLDL-C每增加一个标准差，发生CVD的风险增加14%(HR=1.14, 95% CI: 1.01~1.28)。结论在新疆南疆维吾尔族人群中，高LDL-C累积暴露是该人群发生CVD的独立危险因素，长期保持较低的LDL-C水平，有助于降低该人群CVD的发生风险。
- 低密度脂蛋白胆固醇 /
- 累积暴露 /
- 心血管病 /
- 队列研究
Abstract: Objective To explore the effect of cumulative exposure to low-density lipoprotein cholesterol (LDL-C) on cardiovascular disease (CVD) among the Uyghur population in southern Xinjiang. Methods We recruited 2 950 Uyghurs from the 51st Corps of the 3rd division of Xinjiang Production and Construction Corps, who had measured LDL-C at least three times during the 2016-2022 survey period, and two adjacent measurement intervals ≥2 years. Cumulative LDL-C (cumLDL-C) exposure was calculated by the weighted sum of LDL-C measured value for each time interval (value × time). Participants were grouped according to the cumLDL-C tertiles. The Log-rank test was used to compare the differences in the cumulative incidence of CVD among the groups. Cox proportional hazard regression models were used to estimate the effect of cumLDL-C on CVD. Results During the follow-up period, 322(10.92%) CVD events occurred. The cumulative incidence of CVD from the first to third tertile group of cumLDL-C was 7.12%, 11.08%, and 14.55%, respectively ($ \begin{equation}\chi^2\end{equation}$=27.440, P ＜ 0.001). Cox proportional hazards model showed that after adjusting for multiple confounders, the risk of CVD in the third tertile of cumLDL-C compared with the first tertile was 1.51 times higher (HR=1.51, 95% CI: 1.12-2.06). Each standard deviation increase in cumLDL-C was associated with a 14% increased risk of CVD (HR=1.14, 95% CI: 1.01-1.28). Conclusions In the Uyghur population in southern Xinjiang, cumulative exposure to high LDL-C is an independent risk factor for CVD, and maintaining low LDL-C levels for a long period of time can help reduce the risk of CVD in this population.
- Low-density lipoprotein cholesterol /
- Cumulative exposure /
- Cardiovascular disease /
- Cohort study

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图 1 cumLDL-C各组CVD累积发病率

CVD: 心血管病; cumLDL-C: 低密度脂蛋白胆固醇累积暴露。

Figure 1. Incidence rate of CVD by tertile of cumLDL-C

CVD: cardiovascular disease; cumLDL-C: cumulative low density lipoprotein cholesterol.

下载: 全尺寸图片幻灯片

图 2 cumLDL-C影响CVD的多因素Cox回归模型(敏感性分析)

CVD：心血管病; cumLDL-C：低密度脂蛋白胆固醇累积暴露; 模型1：以是否发生CVD为因变量，以cumLDL-C三分位组(以第一分位组为对照组)为自变量；模型2：在模型1的基础上校正年龄、性别、BMI、基线收缩压、基线舒张压、吸烟、文化程度、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、空腹血糖；模型3：在模型1的基础上校正基线LDL-C。

Figure 2. Multifactorial Cox regression model for the effect of cumLDL-C on CVD (sensitivity analysis)

CVD: cardiovascular disease; cumLDL-C: cumulative low density lipoprotein cholesterol; Model 1: the occurrence of CVD as the dependent variable and the cumLDL-C tertile group (with tertile 1 as the reference) as the independent variable; Model 2: adjusted for age, gender, BMI, baseline systolic blood pressure, baseline diastolic blood pressure, smoking, education, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and fasting plasma glucose based on model 1; Model 3: adjusted for baseline LDL-C based on model 1.

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表 1 cumLDL-C三分位组研究对象的基线特征

Table 1. Baseline characteristics of participants by tertile of cumLDL-C

变量 Variable	cumLDL-C三分位组			总人群 ^① Total ^① (n=2 950)	F/$ \begin{equation} \chi^2 \end{equation}$ 值value	P值 value
变量 Variable	第一分位组 ^① Tertile 1 ^① (n=983)	第二分位组 ^① Tertile 2 ^① (n=984)	第三分位组 ^① Tertile 3 ^① (n=983)	总人群 ^① Total ^① (n=2 950)	F/$ \begin{equation} \chi^2 \end{equation}$ 值value	P值 value
年龄/岁Age/years	42.58±12.22	46.48±11.87^②	47.85±11.84^②，③	45.64±12.18	51.237	＜ 0.001
男性Male	420(42.73)	466(47.36)	453(46.08)	1339(45.39)	4.541	0.103
BMI/(kg·m^-2)	25.77±4.63	26.37±4.61^②	27.04±4.59^②，③	26.40±4.64	18.735	＜ 0.001
SBP/mmHg	125.59±18.12	128.40±19.19^②	130.22±20.06^②	128.07±19.23	14.567	＜ 0.001
DBP/mmHg	74.17±11.48	74.96±11.56	76.11±12.35^②	75.08±11.83	6.695	0.001
cumLDL-C/(mmol·L^-1·年^-1)	9.70±2.52	14.25±0.93^②	18.93±2.79^②，③	14.29±4.38	4 196.084	＜ 0.001
吸烟Smoking	187(19.02)	226(22.97)	215(21.87)	628(21.29)	4.865	0.088
饮酒Drinking	50(5.09)	67(6.81)	76(7.73)	193(6.54)	5.795	0.055
文化程度Education					50.170	＜ 0.001
文盲及半文盲Illiteracy and semi-illiteracy	363(36.93)	465(47.26)^②	473(48.12)^②，③	1 301(44.10)
小学Primary school	296(30.11)	281(28.56)	293(29.81)	870(29.49)
初中Junior high school	257(26.14)	168(17.07)	155(15.77)	580(19.66)
高中及以上Senior high school and above	67(6.82)	70(7.11)	62(6.31)	199(6.75)
TC/(mmol·L^-1)	4.25±1.29	4.69±0.86^②	5.25±1.27^②，③	4.73±1.23	184.657	＜ 0.001
TG/(mmol·L^-1)	1.59±1.44	1.74±1.36	1.90±1.60^②，③	1.74±1.48	10.992	＜ 0.001
HDL-C/(mmol·L^-1)	1.60±0.69	1.46±0.54^②	1.39±0.52^②，③	1.48±0.60	32.536	＜ 0.001
LDL-C/(mmol·L^-1)	1.86±0.69	2.61±0.49^②	3.44±0.75^②，③	2.64±0.92	1 431.809	＜ 0.001
FPG/(mmol·L^-1)	4.95±1.90	4.97±2.09	5.24±2.96^②，③	5.06±2.37	4.764	0.009
血脂异常Dyslipidaemic	260(26.45)	352(35.77)^②	522(53.10)^②，③	1 134(38.44)	151.991	＜ 0.001
服用调脂药Lipotropic drugs users	12(1.22)	21(2.13)	39(3.97)^②，③	72(2.44)	16.155	＜ 0.001
服用降压药Antihypertensive agent users	39(3.97)	48(4.88)	70(7.12)^②	157(5.32)	10.279	0.006
CVD家族史Family history of CVD	136(13.84)	150(15.24)	187(19.02)^②	473(16.03)	10.511	0.005
CVD事件CVD events	70(7.12)	109(11.08)^②	143(14.55)^②，③	322(10.92)	27.915	＜ 0.001
随访时间Follow-up time	6.05±0.98	5.89±1.25^②	5.82±1.29^②	5.92±1.18	9.644	＜ 0.001
注：cumLDL-C，低密度脂蛋白胆固醇累积暴露；SBP，基线收缩压；DBP，基线舒张压；TC，总胆固醇；TG，三酰甘油；HDL-C，高密度脂蛋白胆固醇；LDL-C，低密度脂蛋白胆固醇；FPG，空腹血糖；CVD，心血管病。 ①以人数(占比/%)或x±s表示；②与第一分位组相比，P ＜ 0.05；③与第二分位组相比，P ＜ 0.05。 Note: cumLDL-C, cumulative low density lipoprotein cholesterol; SBP, baseline systolic blood pressure; DBP, baseline diastolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; FPG, fasting plasma glucose; CVD, cardiovascular disease. ① Number of people (proportion/%) or x±s; ② compared with tertile 1, P ＜ 0.05; ③ compared with tertile 2, P＜0.05.

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表 2 cumLDL-C影响CVD的多因素Cox回归模型

Table 2. Multifactorial Cox regression model for the effect of cumLDL-C on CVD

组别Groups	模型1 Model 1 HR值value (95% CI)	模型2 Model 2 HR值value (95% CI)	模型3 Model 3 HR值value (95% CI)
第一分位组Tertile 1	1.00	1.00	1.00
第二分位组Tertile 2	1.60(1.18~2.16)	1.33(0.98~1.81)	1.44(1.05~1.99)
第三分位组Tertile 3	2.12(1.59~2.82)	1.51(1.12~2.06)	1.69(1.16~2.48)
cumLDL-C/+1SD	1.36(1.22~1.51)	1.14(1.01~1.28)	1.33(1.10~1.61)
P_趋势 P_trend	＜ 0.001	0.009	0.008
基线LDL-C Baseline LDL-C	1.32(1.18~1.47)	1.16(1.06~1.33)
注：1. cumLDL-C，低密度脂蛋白胆固醇累积暴露; CVD，心血管病；LDL-C，低密度脂蛋白胆固醇。 2. 模型1，以是否发生CVD为因变量，以cumLDL-C三分位组(以第一分位组为对照组)为自变量；模型2，在模型1的基础上校正年龄、性别、BMI、基线收缩压、基线舒张压、吸烟、文化程度、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、空腹血糖；模型3，在模型1的基础上校正基线LDL-C。 Note: 1. cumLDL-C, cumulative low density lipoprotein cholesterol; CVD, cardiovascular disease; LDL-C, low density lipoprotein cholesterol. 2. Model 1, the occurrence of CVD as the dependent variable and the cumLDL-C tertile group (with tertile 1 as the reference) as the independent variable; Model 2, adjusted for age, gender, BMI, baseline systolic blood pressure, baseline diastolic blood pressure, smoking, education, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and fasting plasma glucose based on model 1; Model 3, adjusted for baseline LDL-C based on model 1.

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