Rationale: In young adults, the role of mildly abnormal lipid levels and lipid variability in the risk of atherosclerotic cardiovascular diseases (ASCVDs) remains uncertain. Objective: To investigate the association of these abnormalities in lipid profiles with the risk of myocardial infarction (MI) and stroke in young population. Methods and Results: From the Korean National Health Insurance Service, a nationwide population-based cohort of 1,934,324 'statin-naive' adults aged 20-39 years, with {greater than or equal to}3 lipid profile measurements and without a history of MI and stroke, were followed-up until the date of MI or stroke, or December 31, 2017. The primary measure of lipid variability was variability independent of the mean. Higher baseline total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), and triglycerides and lower high-density lipoprotein-cholesterol (HDL-C) levels were significantly associated with increased MI risk; respective adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) comparing the highest vs. lowest quartiles were 1.35 (1.20-1.53) for TC, 1.41 (1.25-1.60) for LDL-C, 1.28 (1.11-1.47) for triglycerides, and 0.82 (0.72-0.94) for HDL-C. Adjusted analyses for deciles of lipid profiles showed that MI risk was significantly elevated among participants with TC {greater than or equal to}223.4mg/dL, LDL-C {greater than or equal to}139.5mg/dL, HDL-C {less than or equal to}41.8mg/dL, and triglycerides {greater than or equal to}200.1mg/dL. The associations between lipid levels and stroke risk were less prominent. Multivariable-adjusted restricted cubic spline analysis demonstrated that the increase in MI risk was not exclusively driven by extreme values of lipid profiles. Similar results were obtained on sensitivity analyses of baseline lipid levels. However, associations between lipid variability and the risk of MI and stroke varied depending on the measure of lipid variability used. Conclusions: Mildly abnormal baseline lipid levels were associated with an increased future risk of ASCVD events, particularly MI, whereas measures of lipid variability were not. Therefore, in young adults, achieving optimal lipid levels could be valuable in the prevention of ASCVD.

中文翻译：

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一项“全国未经他汀类药物治疗”的青年人群的脂质水平轻度异常但脂质变异性不高与心肌梗塞和中风的风险增加相关：一项全国队列研究。

理由：在年轻人中，轻度异常血脂水平和血脂变异性在动脉粥样硬化性心血管疾病（ASCVD）风险中的作用仍不确定。目的：探讨这些脂质谱异常与青年人群心肌梗死和中风风险的关系。方法和结果：来自韩国国民健康保险局（Korean National Health Insurance Service）的全国性队列研究，研究对象是年龄在20-39岁之间的1,934,324名“未接受他汀类药物”的成年人，其脂质测量值大于或等于3，并且没有MI史对脑卒中和卒中进行随访，直到心梗或卒中发生日期或2017年12月31日为止。血脂变异性的主要衡量指标是变异性与平均值无关。基线总胆固醇（TC）较高，低密度脂蛋白胆固醇（LDL-C），甘油三酸酯和低密度脂蛋白胆固醇（HDL-C）水平降低与MI风险增加显着相关；分别对最高四分位数和最低四分位数进行比较的调整后危险比（HRs）和95％置信区间（CIs）为TC为1.35（1.20-1.53​​），LDL-C为1.41（1.25-1.60），LDL-C为1.28（1.11-1.47）甘油三酸酯，对于HDL-C为0.82（0.72-0.94）。调整后的脂类分布分析显示，TC参与者{大于或等于} 223.4mg / dL，LDL-C {大于或等于} 139.5mg / dL，HDL-C {小于大于或等于} 41.8mg / dL，而甘油三酸酯{大于或等于} 200.1mg / dL。血脂水平和中风风险之间的关联不太明显。多变量调整的限制性三次样条分析表明，MI风险的增加并非完全由脂质谱的极高值驱动。在基线脂质水平的敏感性分析中获得了相似的结果。但是，脂质变异性与MI和中风风险之间的关联因所用脂质变异性的度量而异。结论：轻度基线血脂异常与ASCVD事件，特别是MI的未来风险增加相关，而血脂变异性的测量则不相关。因此，在年轻人中，达到最佳血脂水平可能对预防ASCVD具有重要意义。脂质变异性与MI和中风风险之间的相关性因所用脂质变异性的度量而异。结论：基线脂质水平轻度异常与ASCVD事件，特别是MI的未来风险增加相关，而脂质变异性的测量则不相关。因此，在年轻人中，达到最佳血脂水平可能对预防ASCVD具有重要意义。脂质变异性与MI和中风风险之间的相关性因所用脂质变异性的度量而异。结论：基线脂质水平轻度异常与ASCVD事件，特别是MI的未来风险增加相关，而脂质变异性的测量则不相关。因此，在年轻人中，达到最佳血脂水平可能对预防ASCVD具有重要意义。