残余胆固醇炎症指数对心血管疾病的预测价值:基于开滦队列的前瞻性研究OA

Objective Based on the large prospective Kailuan cohort study to explore the association between remnant cholesterol(RC)inflammatory index(RCII)and the risk of cardiovascular disease(CVD),as well as its predictive value for CVD.Methods This study was a prospective cohort study.Participants from the Kailuan study population who participated in the 2006 physical examination were included as study subjects(n=101 510).Participants were grouped according to quartiles of RCII:Q1 group(RCII<0.925,n=21 287),Q2 group(0.925≤RCII<2.923,n=21 280),Q3 group(2.923≤RCII<9.293,n=21 293),Q4 group(RCII≥9.293,n=21 286).They were followed up every 2 years.The endpoint of the follow-up was the occurrence of CVD(including stroke and ischemic heart disease),death,or the end of observation(December 31,2022).A Cox proportional hazards regression model was used to analyze the association between RCII and the risk of incident CVD.The predictive values of RC,high-sensitivity C-reactive protein(hs-CRP),and RCII for CVD were compared using C-index,net reclassification improvement(NRI),and integrated discrimination improvement(IDI).RC,hs-CRP,and RCII were standardized using Z-scores and their association with CVD risk was analyzed.Results After an average follow-up of(14.21±3.77)years,among 85 146 study subjects,a total of 10 105 study subjects developed incident CVD.After adjusting for confounding factors and grouping by RCII quartiles,compared with Q1 group,the HR(95%CI)of incident CVD in Q2-Q4 groups were 1.120(1.053-1.191),1.206(1.136-1.282),and 1.347(1.268-1.430),respectively,with P for trend<0.01.For each one standard deviation increase in RCII,the risk of incident CVD increased by 7.2%,and the HR(95%CI)was 1.072(1.055-1.090).ROC curve analysis showed that RCII had the highest area under the curve(AUC)value(0.568),higher than hs-CRP(0.560)or RC(0.544),with P<0.01.The C-index,NRI,and IDI values of RCII were higher than those of RC and hs-CRP.Conclusion The predictive value of RCII for CVD is superior to that of RC or hs-CRP,and as RCII increases,the risk of incident CVD also increases.