Background and aims

This study aimed to evaluate the association between very low levels of low-density lipoprotein (LDL) cholesterol and subsequent clinical outcomes among dyslipidemic patients.

Methods

A retrospective longitudinal study was conducted at a large teaching hospital in Tokyo, Japan, from 2005 to 2018. We included all dyslipidemic adult patients who were followed up at the department of endocrinology. The primary outcome was all-cause mortality and the secondary outcome was cardiovascular disease. We compared the development of these outcomes according to LDL cholesterol categories through longitudinal analyses adjusting for potential confounders.

Results

We included total of 4485 dyslipidemic patients. The mean patient age (standard deviation) was 58.4 (12.2) years, and 2286 patients were men. During a median follow-up of 5.3 (interquartile range 2.2–9.6) years, 252 (5.7%) patients died (25[0.6%] were cardiovascular deaths) and 912 (20.3%) patients developed cardiovascular diseases. Multivariable longitudinal analyses showed that the very low LDL cholesterol group (<60 mg/dl) had significantly higher all-cause mortality than the normal LDL cholesterol group (100–140 mg/dl) (odds ratio[OR] 1.96, 95%confidence interval [CI]:1.22–3.16). Among high-risk patients for atherosclerotic cardiovascular disease (ASCVD), very low LDL cholesterol was significantly associated with increased all-cause mortality (OR 2.61, 95%CI: 1.12–6.10) but decreased incidence of cardiovascular disease (OR 0.47, 95%CI: 0.23–0.93).

Conclusions

Very low LDL cholesterol is associated with increased all-cause mortality but not statistically associated with cardiovascular disease incidence among dyslipidemic patients, regardless of risk. When patients were stratified according to ASCVD risk, this association was more obvious among high-risk patients.

中文翻译：

---

血脂异常患者反复测量的低密度脂蛋白胆固醇与全因死亡率和心血管疾病的关联：一项纵向研究。

背景和目标

这项研究旨在评估血脂异常患者中极低水平的低密度脂蛋白（LDL）胆固醇与随后的临床结局之间的关联。

方法

2005年至2018年，在日本东京的一家大型教学医院进行了一项纵向回顾性研究。我们纳入了所有在内脂科接受随访的血脂异常成人患者。主要结果是全因死亡率，次要结果是心血管疾病。我们通过对潜在混杂因素进行调整的纵向分析，根据LDL胆固醇类别比较了这些结果的发展。

结果

我们纳入了4485名血脂异常患者。平均患者年龄（标准差）为58.4（12.2）岁，男性为2​​286名患者。在5.3年（四分位数范围2.2-9.6）的中位随访期中，有252名（5.7％）患者死亡（25 [0.6％]为心血管死亡），而912名（20.3％）患者患有心血管疾病。多变量纵向分析表明，极低的LDL胆固醇组（<60 mg / dl）的全因死亡率显着高于正常LDL胆固醇组（100–140 mg / dl）（赔率[OR] 1.96，置信度95％区间[CI]：1.22–3.16）。在高风险的动脉粥样硬化性心血管疾病（ASCVD）患者中，极低的LDL胆固醇与全因死亡率增加显着相关（OR 2.61，95％CI：1.12–6.10），但心血管疾病的发生率降低（OR 0.47，95％ CI：0。

结论

极低的LDL胆固醇与全因死亡率增加相关，但与血脂异常患者之间的心血管疾病发生率无统计学相关性，无论其风险如何。当根据ASCVD风险对患者进行分层时，这种关联在高危患者中更为明显。