Objective: To explore the effect of low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio on the severity of coronary artery disease and 2-year adverse events in elderly patients with coronary heart disease. Methods: This prospective, multicenter, observational cohort study was from the prospective observational multicenter cohort for ischemic and hemorrhage risk in coronary artery disease patients (PROMISE) study, in which 18 701 patients with coronary heart disease (CHD) were included from January 2015 to May 2019. Among them, 6 770 elderly patients with CHD were enrolled in the current study. According to the median of LDL-C/HDL-C ratio (2.1), the patients were divided into two groups: low LDL-C/HDL-C group (LDL-C/HDL-C≤2.1, n=3 346) and high LDL-C/HDL-C group (LDL-C/HDL-C2.1, n=3 424). Baseline data and 2-year outcomes (including death, myocardial infarction, revascularization, stroke) were collected and analyzed in order to found the differences of elderly CHD patients with different LDL-C/HDL-C levels, and explore the correlation between LDL-C/HDL-C ratio with the severity of coronary artery disease and prognosis using Cox multivariate regression analysis. Results: Patients in the low LDL-C/HDL-C group were older [(71.9±5.5) vs (71.5±5.4) years old, P=0.003], and there was no statistically significant difference in the proportion of males between the two groups (61.9% vs 63.4%,P=0.208). The indicators reflecting the severity of coronary artery lesions, including the number of target lesions, the number of coronary artery disease, preoperative SNYTAX score, and the proportion of triple-vessel disease (1.01±0.81 vs 0.88±0.78, 2.28±0.81 vs 2.14±0.83, 16.05±10.67 vs 13.59±9.49, 49.0% vs 41.0%, respectively, all P0.05) were higher in the high LDL-C/HDL-C group. The 2-year follow-up showed that there was no statistically significant difference in the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), all-cause mortality, cardiac death, myocardial infarction, and revascularization between the high LDL-C/HDL-C ratio group and the low LDL-C/HDL-C ratio group. Compared by gender, the incidence of all-cause death and cardiac death in the high LDL-C/HDL-C group of female patients were higher than the low LDL-C/HDL-C group (6.9% vs 4.8%, 5.3% vs 3.7%, both P0.05, respectively); There was no statistically difference in the incidence of adverse events between the two groups of male patients. Cox multivariate regression analysis showed that, regardless of gender, the LDL-C/HDL-C ratio was not a risk factor for 2-year MACCE in elderly patients with CHD (male: HR=1.21, 95%CI: 0.87-1.69; female: HR=0.96, 95%CI: 0.65-1.43;total: HR=1.09, 95%CI: 0.85-1.39,all P0.05). Conclusions: The severity of coronary artery disease is higher in elderly patients with high LDL-C/HDL-C ratio than in those with low LDL-C/HDL-C ratio. The LDL-C/HDL-C ratio is not a risk factor for 2-year adverse cardiovascular and cerebrovascular events in elderly patients with coronary heart disease. However, the incidences of 2-year adverse cardiovascular events of female patients with high LDL-C/HDL-C ratio are higher than patients with low LDL-C/HDL-C ratio.
目的： 分析低密度脂蛋白胆固醇（LDL-C）/高密度脂蛋白胆固醇（HDL-C）与老年冠心病患者冠状动脉病变严重程度和2年预后的关联。 方法： 前瞻性多中心队列研究，研究对象来源于中国冠心病患者血栓和出血评分系统（PROMISE）研究，入选2015年1月至2019年5月8个区域性三级医院18 701例确诊冠心病患者。研究纳入≥65岁老年冠心病患者6 770例，根据LDL-C/HDL-C的中位数（2.1）将患者分为低LDL-C/HDL-C组（LDL-C/HDL-C≤2.1，n=3 346）和高LDL-C/HDL-C组（LDL-C/HDL-C2.1，n=3 424）。收集基线资料，并进行2年随访，记录死亡、心肌梗死、血运重建、卒中等心脑血管不良事件的发生情况，比较不同LDL-C/HDL-C水平老年冠心病患者之间的差异，多因素Cox回归模型分析LDL-C/HDL-C与患者冠状动脉病变严重程度及2年预后的关联。 结果： 低LDL-C/HDL-C组年龄大于高LDL-C/HDL-C组［（71.9±5.5）比（71.5±5.4）岁，P=0.003］，两组男性占比差异无统计学意义（61.9%比63.4%，P=0.208）。高LDL-C/HDL-C组靶病变个数、冠状动脉病变支数、术前SNYTAX评分及三支病变比例均高于低LDL-C/HDL-C组［分别为（1.01±0.81）比（0.88±0.78）个、（2.28±0.81）比（2.14±0.83）支、（16.05±10.67）比（13.59±9.49）分、49.0%比41.0%，均P0.05］。2年随访结果显示，高LDL-C/HDL-C组与低LDL-C/HDL-C组主要不良心脑血管事件（MACCE）、全因死亡、心源性死亡、心肌梗死及血运重建发生率差异均无统计学意义（均P0.05）。按不同性别比较，女性高LDL-C/HDL-C组全因死亡及心源性死亡发生率高于低LDL-C/HDL-C组（分别为6.9%比4.8%、5.3%比3.7%，均P0.05）；男性两组间各不良事件发生率差异无统计学意义（均P0.05）。多因素Cox回归模型分析结果显示，无论男性还是女性，LDL-C/HDL-C都不是老年冠心病患者2年MACCE的危险因素（男性：HR=1.21，95%CI：0.87~1.69；女性：HR=0.96，95%CI：0.65~1.43；合计：HR=1.09，95%CI：0.85~1.39，均P0.05）。 结论： 老年冠心病患者高LDL-C/HDL-C比值者冠状动脉病变的严重程度高于低LDL-C/HDL-C者。LDL-C/HDL-C虽然不是老年冠心病患者2年不良心脑血管事件的危险因素，但高LDL-C/HDL-C女性2年不良心血管事件发生率高于低LDL-C/HDL-C女性。.