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Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study
BACKGROUND: Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrit...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056540/ https://www.ncbi.nlm.nih.gov/pubmed/33874960 http://dx.doi.org/10.1186/s12944-021-01460-6 |
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author | Wang, Bo Liu, Jin Chen, Shiqun Ying, Ming Chen, Guanzhong Liu, Liwei Lun, Zhubin Li, Huanqiang Huang, Haozhang Li, Qiang Yu, Yaren Lin, Mengfei Wei, Wen Huang, Zhidong Yang, Yongquan Chen, Jiyan Tan, Ning Liu, Yong |
author_facet | Wang, Bo Liu, Jin Chen, Shiqun Ying, Ming Chen, Guanzhong Liu, Liwei Lun, Zhubin Li, Huanqiang Huang, Haozhang Li, Qiang Yu, Yaren Lin, Mengfei Wei, Wen Huang, Zhidong Yang, Yongquan Chen, Jiyan Tan, Ning Liu, Yong |
author_sort | Wang, Bo |
collection | PubMed |
description | BACKGROUND: Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition. METHOD: A total of 41,229 CAD patients admitted to Guangdong Provincial People’s Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. RESULT: In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05–7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96–1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83–0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84–0.99). CONCLUSION: This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition. |
format | Online Article Text |
id | pubmed-8056540 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-80565402021-04-20 Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study Wang, Bo Liu, Jin Chen, Shiqun Ying, Ming Chen, Guanzhong Liu, Liwei Lun, Zhubin Li, Huanqiang Huang, Haozhang Li, Qiang Yu, Yaren Lin, Mengfei Wei, Wen Huang, Zhidong Yang, Yongquan Chen, Jiyan Tan, Ning Liu, Yong Lipids Health Dis Research BACKGROUND: Several studies have found that a low baseline low -density lipoprotein cholesterol (LDL-C) concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which is called the “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. The aim of this study was to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition. METHOD: A total of 41,229 CAD patients admitted to Guangdong Provincial People’s Hospital in China were included in this study from January 2007 to December 2018 and divided into two groups (LDL-C < 1.8 mmol/L, n = 4863; LDL-C ≥ 1.8 mmol/L, n = 36,366). The Kaplan-Meier method and Cox regression analyses were used to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. RESULT: In this real-world cohort (mean age 62.9 years; 74.9% male), there were 5257 cases of all-cause death during a median follow-up of 5.20 years [interquartile range (IQR): 3.05–7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with a worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that a low LDL-C level (< 1.8 mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96–1.24). After adjustment for nutritional status, the risk of all-cause mortality in patients with low LDL-C levels decreased (adjusted HR, 0.90; 95% CI, 0.83–0.98). In the final multivariate Cox model, a low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84–0.99). CONCLUSION: This study demonstrated that the cholesterol paradox existed in CAD patients but disappeared after accounting for the effects of malnutrition. BioMed Central 2021-04-19 /pmc/articles/PMC8056540/ /pubmed/33874960 http://dx.doi.org/10.1186/s12944-021-01460-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Wang, Bo Liu, Jin Chen, Shiqun Ying, Ming Chen, Guanzhong Liu, Liwei Lun, Zhubin Li, Huanqiang Huang, Haozhang Li, Qiang Yu, Yaren Lin, Mengfei Wei, Wen Huang, Zhidong Yang, Yongquan Chen, Jiyan Tan, Ning Liu, Yong Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title | Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title_full | Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title_fullStr | Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title_full_unstemmed | Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title_short | Malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 Chinese cohort study |
title_sort | malnutrition affects cholesterol paradox in coronary artery disease: a 41,229 chinese cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056540/ https://www.ncbi.nlm.nih.gov/pubmed/33874960 http://dx.doi.org/10.1186/s12944-021-01460-6 |
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