A cohort study of the effect of cumulative exposure to LDL-C on cardiovascular disease among the uyghur population in southern Xinjiang
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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}$=27.440, P < 0.001)。Cox比例风险回归模型显示,校正多种混杂因素后,与cumLDL-C第一分位组相比,cumLDL-C第三分位组发生CVD的HR=1.51(95% CI: 1.12~2.06);cumLDL-C每增加一个标准差,发生CVD的风险增加14%(HR=1.14, 95% CI: 1.01~1.28)。 结论 在新疆南疆维吾尔族人群中,高LDL-C累积暴露是该人群发生CVD的独立危险因素,长期保持较低的LDL-C水平,有助于降低该人群CVD的发生风险。 Abstract:Objective To explore the effect of cumulative exposure to low-density lipoprotein cholesterol (LDL-C) on cardiovascular disease (CVD) among the Uyghur population in southern Xinjiang. Methods We recruited 2 950 Uyghurs from the 51st Corps of the 3rd division of Xinjiang Production and Construction Corps, who had measured LDL-C at least three times during the 2016-2022 survey period, and two adjacent measurement intervals ≥2 years. Cumulative LDL-C (cumLDL-C) exposure was calculated by the weighted sum of LDL-C measured value for each time interval (value × time). Participants were grouped according to the cumLDL-C tertiles. The Log-rank test was used to compare the differences in the cumulative incidence of CVD among the groups. Cox proportional hazard regression models were used to estimate the effect of cumLDL-C on CVD. Results During the follow-up period, 322(10.92%) CVD events occurred. The cumulative incidence of CVD from the first to third tertile group of cumLDL-C was 7.12%, 11.08%, and 14.55%, respectively ($ \begin{equation}\chi^2\end{equation}$=27.440, P < 0.001). Cox proportional hazards model showed that after adjusting for multiple confounders, the risk of CVD in the third tertile of cumLDL-C compared with the first tertile was 1.51 times higher (HR=1.51, 95% CI: 1.12-2.06). Each standard deviation increase in cumLDL-C was associated with a 14% increased risk of CVD (HR=1.14, 95% CI: 1.01-1.28). Conclusions In the Uyghur population in southern Xinjiang, cumulative exposure to high LDL-C is an independent risk factor for CVD, and maintaining low LDL-C levels for a long period of time can help reduce the risk of CVD in this population. -
图 2 cumLDL-C影响CVD的多因素Cox回归模型(敏感性分析)
CVD:心血管病; cumLDL-C:低密度脂蛋白胆固醇累积暴露; 模型1:以是否发生CVD为因变量,以cumLDL-C三分位组(以第一分位组为对照组)为自变量;模型2:在模型1的基础上校正年龄、性别、BMI、基线收缩压、基线舒张压、吸烟、文化程度、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、空腹血糖;模型3:在模型1的基础上校正基线LDL-C。
Figure 2. Multifactorial Cox regression model for the effect of cumLDL-C on CVD (sensitivity analysis)
CVD: cardiovascular disease; cumLDL-C: cumulative low density lipoprotein cholesterol; Model 1: the occurrence of CVD as the dependent variable and the cumLDL-C tertile group (with tertile 1 as the reference) as the independent variable; Model 2: adjusted for age, gender, BMI, baseline systolic blood pressure, baseline diastolic blood pressure, smoking, education, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and fasting plasma glucose based on model 1; Model 3: adjusted for baseline LDL-C based on model 1.
表 1 cumLDL-C三分位组研究对象的基线特征
Table 1. Baseline characteristics of participants by tertile of cumLDL-C
变量
VariablecumLDL-C三分位组 总人群 ①
Total ①
(n=2 950)F/$ \begin{equation} \chi^2 \end{equation}$
值valueP值
value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) 年龄/岁Age/years 42.58±12.22 46.48±11.87② 47.85±11.84②,③ 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±4.61② 27.04±4.59②,③ 26.40±4.64 18.735 < 0.001 SBP/mmHg 125.59±18.12 128.40±19.19② 130.22±20.06② 128.07±19.23 14.567 < 0.001 DBP/mmHg 74.17±11.48 74.96±11.56 76.11±12.35② 75.08±11.83 6.695 0.001 cumLDL-C/(mmol·L-1·年-1) 9.70±2.52 14.25±0.93② 18.93±2.79②,③ 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±0.86② 5.25±1.27②,③ 4.73±1.23 184.657 < 0.001 TG/(mmol·L-1) 1.59±1.44 1.74±1.36 1.90±1.60②,③ 1.74±1.48 10.992 < 0.001 HDL-C/(mmol·L-1) 1.60±0.69 1.46±0.54② 1.39±0.52②,③ 1.48±0.60 32.536 < 0.001 LDL-C/(mmol·L-1) 1.86±0.69 2.61±0.49② 3.44±0.75②,③ 2.64±0.92 1 431.809 < 0.001 FPG/(mmol·L-1) 4.95±1.90 4.97±2.09 5.24±2.96②,③ 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±1.25② 5.82±1.29② 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.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 Ptrend < 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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