Relationship Between Remnant Cholesterol And The Risk Of Premature Coronary Heart Disease And Severity Of Coronary Artery Disease

Objective:The objective of this study is to examine the correlation between remnant cholesterol(RC)and the risk of premature coronary artery disease(p CHD),as well as the severity of coronary artery lesions.Method:We conducted a study of 637 patients(male ≤ 55 years old and female ≤ 65 years old)who were admitted to the Affiliated Hospital of Qingdao University between January 2018 and June 2022 with suspected coronary heart disease.All patients underwent coronary arteriography(CAG).The study collected general clinical,laboratory,and angiography data of the patients.The calculation of remnant cholesterol(RC)is total cholesterol(TC)minus low-density lipoprotein cholesterol(LDL-C)minus high-density lipoprotein cholesterol(HDL-C).The severity of coronary artery lesions was assessed using the GS score,based on the results of coronary angiography.Patients were separated into p CHD(n = 369)and non-p CHD groups(n = 268)according to the results of angiography.The nearest neighbor matching method of propensity score matching(PSM)was used to provide 1:1 matching between the p CHD and non-p CHD groups,using a caliper value of 0.05.The matching model considered the age and gender of the p CHD and non-p CHD groups for the treatment variable.Confounding variables were successfully balanced to balance the comparison between groups.The p CHD group was divided into mild lesion group(GS ≤ 36,n = 188)and severe lesion group(GS > 36,n = 181)according to the median GS score.The general clinical and laboratory data of each group were compared using statistical analyses.Logistic regression analysis was conducted to identify whether RC is an independent predictor of the prevalence and severity of coronary artery disease in p CHD patients.A receiver operating characteristic(ROC)curve was used to evaluate the predictive value of RC for p CHD occurrence.Significance was set at P < 0.05.Results:1.There were significant differences in age,gender,smoking,diabetes and Body Mass Index(BMI)between the p CHD group and the non-PCHD group before PSM(P < 0.05).Laboratory data showed that HDL-C and apolipoprotein A1(apo A1)in the p CHD group were significantly lower than those in the non-PCHD group(P < 0.05),and the difference was statistically significant.The levels of TG,TC,LDL-C,Apolipoprotein B(apo B),fasting blood glucose(FBG),Alanine transferase(ALT)in the p CHD group were significantly higher than those in the non-PCHD group(P < 0.05).ALT,Creatinine(Cr),Uric acid(UA),and RC levels in the p CHD group were significantly higher than those in the non-PCHD group(P < 0.05),and the differences were statistically significant.There was no significant difference in Lp(a)[Lp(a)] and estimated glomerular filtration rate(e GFR)between the two groups(P = 0.384,P = 0.532).2.After PSM,217 patients were included in the p CHD group and 217 patients in the non-PCHD group.There were no significant differences in age,gender,smoking history,hypertension,and diabetes history between the p CHD group and the non-PCHD group(P >0.05).The BMI of the p CHD group was significantly higher than that of the non-PCHD group,and the difference was statistically significant(P = 0.020).The levels of TC,TG,LDL-C,apo B,ALT,Cr,and RC in the p CHD group were significantly higher than those in the non-PCHD group,while the e GFR in the p CHD group was significantly lower than that in the non-PCHD group(P < 0.05).There were no significant differences in HDL-C,Lp(a),apo A1 and UA between the two groups(P > 0.05).3.There were no significant differences in age,gender,smoking history,hypertension history,and BMI between the mild lesion group and the severe lesion group(P > 0.05).There was a significant difference in the prevalence of diabetes between the two groups(P= 0.001).The levels of TC,LDL-C,and RC in the severe group were significantly higher than those in the mild group(P < 0.05),and the difference was statistically significant.HDL-C and apo A1 in the severe group were significantly lower than those in the mild group(P < 0.05).There were no significant differences in TG,Lp(a),apo B,FBG,ALT,Cr,and UA between the two groups(P > 0.05).4.RC is an independent risk factor for p CHD(P < 0.001).Elevated FBG and decreased e GFR were also independent risk factors for p CHD(P = 0.002).5.RC and diabetes mellitus are independent risk factors for severe coronary lesions in p CHD patients(P < 0.05).Apo A1 was an independent protective factor for severe coronary artery lesions in p CHD patients(P = 0.014).Multiple linear regression analysis showed that gender,diabetes,LDL-C,and RC were independent risk factors for the severity of coronary artery lesions(P < 0.05),and apo A1 was an independent protective factor for the severity of coronary artery lesions(P < 0.05).6.RC was positively correlated with GS score in p CHD patients(P < 0.001),while apo A1 was negatively correlated with the GS score in p CHD patients(P = 0.001).7.The area under the ROC curve of RC was 0.779(95% CI: 0.736-0.823,P < 0.001).With RC = 0.61 as the best cut-off value,the sensitivity was 64%,and the specificity was83%.Conclusion:1.RC is an independent risk factor for the onset of p CHD and has a certain predictive value.2.There was a positive correlation between RC level and GS score,and a negative correlation between apo A1 level and GS score in p CHD patients.3.RC is an independent risk factor,and apo A1 is an independent protective factor for the severity of coronary artery disease in p CHD patients.