Association Of Non-High-Density Lipoprotein Cholesterol And Increment Of 30-Min Post-Challenge Plasma Glucose With Major Abnormal Electrocardiogram

BackgroundThe prevalence of cardiovascular disease(CVD)is increasing every year and there is an urgent need to identify people at risk for the disease early enough to allow for timely intervention.Among the many risk factors for CVD,metabolic factors such as lipid and glucose abnormalities are the main and modifiable risk factors for CVD.Among these lipid indicators,non-HDL cholesterol(non-HDL-C)has recently been recognised as an important factor in clinical screening,diagnosis and treatment.A large number of observational studies have clarified the positive association between non-HDLC levels and CVD risk.However,most of these studies have used the presence of clinical events such as myocardial infarction,stroke and angina pectoris as an observational indicator of CVD,while the relationship between ECG and non-HDL-C,which is an important and easy way to identify people at risk of CVD,has been less studied.All ECGs have a corresponding Minnesota code(MC),which standardises and standardises ECG results and reduces the variation in results caused by subjective human interpretation.Longitudinal studies have shown that MA-ECG is a stronger predictor of CVD risk than other traditional risk factors.Therefore,in order to identify individuals with elevated nonHDL-C levels at an early stage of CVD risk,the first part of this paper examines the relationship between different non-HDL-C levels and MA-ECG in the Chinese adult population.Similarly,the association between elevated postprandial glucose and glucose fluctuations and CVD has been validated in previous studies,but most of these studies have focused on people with diabetes mellitus(DM)and the time point during the oral glucose tolerance test(OGTT)has been chosen to be 2 hours post-glucose(2h PG).In clinical practice,there are still individuals with normal fasting glucose(FPG)and 2h PG but significantly elevated 30-minute glucose(30min PG)levels,and it is of interest whether these subjects are also at high risk of CVD.It is well documented that the 30-minute post-glycaemic increment(Δ30min PG,calculated as 30 min PG minus FPG),a proxy for early postprandial glucose fluctuations,is clearly associated with an increased urinary creatinine ratio(ACR),which is an important risk factor for CVD.The second part of this paper examines the relationship between Δ30min PG and MA-ECG as a risk indicator for CVD in normal glucose tolerance(NGT),impaired glucose regulation(IGR),and DM populations,respectively,to identify the risk of CVD in individuals with early glycaemia after taking sugar.This study was conducted to identify the risk of CVD in individuals with elevated blood glucose after glucose load.Section 1: Association of non-high-density lipoprotein cholesterol with major abnormal electrocardiogram ObjectiveWe aim to analyze the association between non-high-density lipoprotein cholesterol(non-HDL-C)level and Minnesota code-indicated major abnormal electrocardiogram among Chinese adult population.MethodsFrom the Chinese Diabetes and Metabolic Disorders Study(CNDMDS),34 000 people aged 20 years or older with complete data on ECG,high-density lipoprotein cholesterol(HDL-C)and total cholesterol(TC)were screened and quartile grouped by non-HDL-C level,and one-way ANOVA and χ2 test were performed to make comparisons of the differences of each index and the prevalence of MA-ECG among different groups.Logistic regression was used to analyse the correlation of non-HDL-C with MA-ECG and each MA-ECG Minnesota code.Based on multi-factor logistic regression,the interaction between each risk factor and non-HDL-C on the prevalence of MA-ECG was evaluated,and the p-value of the interaction was calculated.ResultsThe 34,000 individuals were quartile grouped according to non-HDL-C levels,as non-HDL-C levels increased,the prevalence of MA-ECG also increased significantly.Logistic regression analysis showed that non-HDL-C was independently associated with MA-ECG after correcting for age,sex,BMI,WHR,smoking,hypertension,history of CVD,family history of CVD,and diabetes mellitus.Using group Q1 as a reference,groups Q2(OR 1.148,95% CI 1.012-1.302,p=0.032),Q3(OR 1.142,95% CI 1.007-1.294,p=0.038)and Q4(OR 1.264,95% CI 1.116-1.431,p<0.001)had a MA-ECG The risk was significantly higher.The results of the trend test showed that the correlation was consistent with a linear trend(p<0.001).Correlation analysis of non-HDL-C levels with each MAECG Minnesota code showed that,after correction,the risk of prevalence for 1-code(OR1.195,95% CI 1.043-1.369,p<0.001)and 4-and 5-codes(OR 1.115,95% CI 1.059-1.174,p<0.001)was associated with non-HDL-C levels were significantly positively associated,7-code prevalence risk was not associated with non-HDL-C levels,while 6-code(OR0.751,95% CI 0.581-0.970,p=0.029)and 8-code(OR 0.556,95% CI 0.433-0.716,p<0.001)prevalence risk was negatively associated with non-HDL-C levels were negatively associated.The results of the interaction showed that there were interactions between age,BMI,hypertension and non-HDL-C(P values for interaction were 0.036,0.034 and 0.014,respectively).ConclusionNon-HDL-C is an independent risk factor for MA-ECG,and the risk of MA-ECG increases with higher non-HDL-C levels.Moreover,age,BMI,and hypertension all interacted on the correlation between non-HDL-C and MA-ECG.Section 2:Association between increment of 30-min post-challenge plasma glucose and major abnormal electrocardiogramObjective The aim of this study was to investigate the relationship between the increment of 30-min post-challenge plasma glucose(Δ30min PG)and MA-ECG in Chinese adult population.Methods From the CNDMDS,NGT,IGR and DM subjects were screened according to the WHO diagnostic criteria for DM,and then excluded from each of these three populations:missing ECG data or no Minnesota-coded ECG results;missing 30 min PG;Δ30min PG ≤0;incomplete general data or presence of outliers,resulting in the inclusion of 16,365 NGT subjects,5418 IGR subjects and 3730 DM subjects into the statistical analysis.Theχ2 test and one-way ANOVA were used to compare the differences in indicators and MAECG prevalence among different groups in each population according to the Δ30min PG level quartiles.Logistic regression was used to analyse the correlation between Δ30min PG and MA-ECG in each population.In the NGT population,the interaction between risk factors and Δ30min PG levels on the risk of MA-ECG was assessed based on multifactorial logistic regression.The differences in prevalence of different blood glucose related indicators were compared and the correlation between each blood glucose indicator and MA-ECG was analyzed using logistic regression.Results In the NGT population,the mean Δ30min PG was 3.19±1.58 mmol/L,and the prevalence of MA-ECG was 7.5%(1230/16365).When corrected for age,sex,BMI,WHR,smoking,hypertension,history of CVD,family history of CVD,and hyperlipidemia,the risk of MA-ECG was significantly higher in the Q4 group(OR 1.219,95% CI 1.030-1.442,P=0.021)compared with the Q1 group,suggesting that Δ30min PG was an independent risk factor for MA-ECG.There was a trend in this logistic regression model,that is,overall,the higher the level of Δ30min PG,the higher the risk of developing MAECG.To evaluate the interaction between risk factors and Δ30min PG on the risk of MAECG,the results showed that no interaction between age,sex,BMI,WHR,smoking,hypertension,history of CVD,family history of CVD,hyperlipidemia and Δ30min PG was found(P for interaction>0.05).The absolute values of FPG,30 min PG,2h PG,and 2h PG-FPG were grouped according to quartiles,and significant differences were found between groups for each index,except for no significant differences in the prevalence of MA-ECG between the four subgroups of FPG.logistic regression analysis corrected,there were no significant correlations between each glycemic index and MA-ECG.The FPG was grouped according to the median and 5.6 cut points,and after correction,Δ30min PG was significantly associated with the risk of MA-ECG in the FPG>4.9 mmol/L group and the FPG≥5.6 mmol/L group.In the IGR population,using the Q1 group as a reference,the risk of MA-ECG was significantly higher in the corrected Q3 group(OR 1.317,95% CI 1.019-1.703,P=0.035).In the DM population,the risk of MA-ECG was significantly higher in the corrected Q4 group(OR 1.411,95% CI 1.065-1.870,P=0.016),using the Q1 group as a reference.Conclusion In the NGT,IGR,and DM populations,Δ30min PG was an independent risk factor for MA-ECG,and the risk of MA-ECG prevalence increased with increasing Δ30min PG.Age,gender,BMI,WHR,smoking,hypertension,history of CVD,family history of CVD,and hyperlipidemia were also found to have no interactive effect on the association between Δ30min PG and MA-ECG in the NGT population,and all glucose-related indexes were not associated with the risk of MA-ECG prevalence except Δ30min PG.