| Objective To observe the changes of remnant cholesterol in patients with Acute coronary syndromes treated with statins,and to analyze the correlation between remnant cholesterol and the prognosis in patients with ACS with and without type 2 diabetes,so as to provide valuable clinical data for the development of individualized treatment plan for ACS patients.Methods This study selected inpatients diagnosed with ACS who visited the Second Affiliated Hospital of Nantong University from January 1,2020 to December 31,2020,and recorded their basic information such as age,gender,BMI,past medical history,blood routine examination,liver and kidney function,and color doppler echocardiography.All patients were treated with statins for lipid regulation.Blood lipids of the patients were collected during outpatient follow-up 4-6 weeks after discharge,and the patients were followed up within 1 year after discharge,mainly through outpatient follow-up or telephone contact to understand the survival status of the patients at that time.All-cause death,re-coronary revascularization due to myocardial ischemia,readmission to hospital due to unstable angina or heart failure,and nonfatal stroke were the primary end points.Patients were divided into type 2diabetes group and non-type 2 diabetes group.The difference in correlation between RC level and prognosis of ACS patients in the two groups was observed.Results A total of 327 patients(mean age 66(56,75)years old,247 males(75.5%))were included in this study,including 113patients(mean age 65.4±11.6 years old,86 males(76.1%)with type2 diabetes.There were 214 patients without type 2 diabetes [mean age 65(56,75)years,161 males(75.2%)].At a mean follow-up of12±4 months,62 patients(19.0%)had an end-point event,including21 all-cause deaths(6.4%),3 strokes(0.9%),3 recurrent mi(0.9%),and 35 UAP or HF readmissions(11.5%).Data analysis showed that RC was positively correlated with TC(r=0.290,P <0.001),TG(R=0.577,P <0.001),LDL-C(R =0.205,P <0.001),hs-CRP(r=0.123,P=0.038),and HDL-C(R =-0.360,P <0.001)were negatively correlated.The baseline RC of ACS patients with type 2 diabetes was higher than that of the non-type 2 diabetes group,the difference was statistically significant(P =0.042),but there was no significant difference in the reduction of RC after treatment or before and after treatment between the two groups.The RC of patients with ACS after statin treatment was significantly lower than before,regardless of type 2 diabetes(p=0.001;Non-t2 dm group,p=0.000).In terms of prognosis,univariate and multivariate Logistic regression analysis was performed on the baseline data of the patients.Age and baseline RC were significantly correlated with MACEs of ACS patients included in the study(OR=1.055,1.060,95%CI=1.007-1.104,1.014-1.109,P =0.024,0.011).The area under ROC curve for RC to determine MACEs in ACS patients was 0.666(optimal critical value was 14.51mg/ d L,sensitivity was 77.4%,specificity was 50.6%).In addition,baseline RC and serum urea nitrogen were closely correlated with MACEs in ACS patients with type 2 diabetes(P=0.005,0.033),and the area under ROC curve was 0.783(the optimal critical value was 17.8mg/ d L,and the sensitivity was84.0%.The specificity was 62.5%)and 0.737(the optimal threshold was 7.07mmol/L,the sensitivity was 68.0%,the specificity was75.0%).After treatment,RC was not associated with adverse cardiovascular events in patients with ACS,regardless of type 2diabetes.Conclusions 1.ACS patients with type 2 diabetes have a higher level of RC,but the efficacy of statins in reducing RC is not affected by type 2 diabetes.2.In the ACS population included in this study,age and baseline RC levels independently predicted major adverse cardiovascular events.3.In ACS patients with type 2diabetes,baseline RC and serum urea nitrogen levels were independent risk factors for compound adverse end points.4.After statin treatment for 4-6 weeks,RC levels did not predict 1-year compound adverse end points in patients with ACS,regardless of type 2 diabetes. |
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