The Relationship Between High-density Lipoprotein And The Recurrence Of Atherosclerotic Cardiovascular Disease

Background and purpose In recent years,as people's living standards continue to rise,and the change in diet,the incidence of cardiovascular and cerebrovascular disease in China is also gradually increased,especially acute coronary syndrome(acute coronary syndrome ACS),ischemic stroke,these diseases affect people's quality of life seriously,bring a hard burden to the community.At present,we can significantly reduce the incidence of ACS and mortality and improve the survival rate of patients with acute stroke through the anti-platelet therapy,anticoagulant,lipid-stabilized plaque and other treatment.However,some patients still have to face atherosclerosis The risk of re-onset of atherosclerotic cardiovascular disease(ASCVD)even after treatment.The main pathological basis of coronary heart disease is atherosclerosis(AS).A large number of epidemiological studies have shown that dyslipidemia is an important risk factor for ASCVD;Lowering the level of low density lipoprotein cholesterol(LDL-C)can reduce the morbidity and mortality of ASCVD effectively.A large number of epidemiological tests and basic studies have shown that LDL-C level is positively correlated with AS and the level of high density lipoprotein cholesterol(HDL-C)is negatively correlated with the incidence of AS;The Reduction of LDL-C and the elevation of HDL-C can reduce the risk of ASCVD which has become a consensus.People has studied the mechanism of LDL metabolic research in-depth,and in clinical by increasing the activity of LDL receptor with lipid-lowering drugs,to reduce LDL-C serum concentration,thereby reduce the incidence of cardiovascular and cerebrovascular disease.Be different from LDL,the understanding of HDL is often limited.In recent years,patients with coronary heart disease to have coronary heart disease secondary prevention and treatment with statins and other lipid-lowering drugs to lower cholesterol,low density lipoprotein cholesterol,there are still some patients re-emergence of atherosclerotic cardiovascular disease.Therefore,it is necessary for us to study the mechanism of HDL-C in-depth in the recurrence of atherosclerotic cardiovascular disease.This study is to explore the relationship between high density lipoprotein cholesterol(HDL-C)and the recurrence of ASCVD,to provide clinical trial basis for the use of lipid-lowering drugs in ASCVD patients.The method A total of 307 hospitalizd patients with acute coronary syndrome first diagnosed during January 2007 to December 2010 in the hospital,were enrolled.All the patients were diagnosed by coronary angiography and had underwent selective percutaneous coronary artery intervention(PCI)successfully;Then once every follow-up them every 6 month,the final time is December 2016,the endpoint is the recurrence of the atherosclerotic cardiovascular disease.Among 307 cases,we have observed 128 cases patients with recurrence,179 cases with no recurrence and all of the 179 patients had a review of coronary angiography.After admission to conventional detailed history,physical check-up,recording vital signs,gender,age,weight,height,smoking past medical history data,and make 12 or 18 couplet table electrocardiogram,routine biochemistry,myocardial injury markers,such as heart colour to exceed,the X-ray check.Exclusion criteria:(1)previous ischemic stroke;(2)previous or current atrial fibrillation patients;(3)New York heart association class ? heart function and left ventricular ejection fraction(LVEF)? 35%;(4)serious liver and kidney function damage;(5)with malignant tumor,thyroid dysfunction,peripheral vascular disease,immune system disease patients;(6)Recently havetaken Lipid-lowering drugs which will affect the detection index;(7)Taking anticoagulants such as warfarin,and sugar cortical hormone drugs.Result The patients were followed up once every 6 months and followed up to December 31,2016,to observe the end point for the recurrence of atherosclerotic cardiovascular disease.Follow-up(3.96 ± 2.05)years,a total of 128 patients with recurrent atherosclerotic cardiovascular disease,179 cases without recurrence and had a review of coronary angiography;According to HDL-C levels,the patients were divided into high HDL-C group(? 1.55(1.04 ~ 1.54 mmol / L)and low HDL-C(<1.04 mmol / L)in normal HDL-C group.SPSS21.0 software was used to analyze the data,and the risk of recurrence of patients with different HDL-C levels was compared.Results: The proportion of HDL-C group,normal HDL-C group and low HDL-C group was 4.56%(14/307),60.91%(187/307)and 34.53%(106/307)respectively,(P <0.01).The rate of recurrence of HDL-C group was shorter than that of HDL-C group and normal HDL-C group(P <0.01);HDL-C group was significantly higher than that in HDL-C group.The lower the level of TC,the lower the HDL-C / TC ratio(P <0.01).Multivariate Cox regression analysis showed that the incidence of atherosclerotic cardiovascular disease in patients with HDL-C?0.91 mmol / L increased by 1.992 times(HR = 1.992,95%)compared with HDL-C?1.25 mmol / CI = 1.02 ~ 3.88,P = 0.043)and 0.91 ~ 1.05 mmol / L,the recurrence rate of atherosclerotic cardiovascular disease was 2.496 times(HR = 2.496,95% CI: 1.33 ~ 4.68,P = 0.004)The Follow-up(3.96 ± 2.05)years,a total of 128 patients with recurrent atherosclerotic cardiovascular disease.(LDL-C> 1.8 mmol / L)in patients with recurrent ASCVD,LDL-C(LDL-C?1.8 mmol / L or decreased by ? 50%),39.06%(50 /(+ 1.55 mmol / L),the normal HDL-C group(1.04 ~ 1.54 mmol / L)and the low HDL-C group were significantly higher than those in the control group(P <0.05),60.94%(78/128)(<1.04 mmol / L)were 8%(4/50),50%(25/50)and 42%(21/50)respectively.In conclusion: 1.With the decrease in HDL-C levels,the risk of recurrence of atherosclerotic cardiovascular disease is on the rise.2.High-density lipoprotein levels in patients with atherosclerotic cardiovascular disease recurrence is generally low.