10. Đặc điểm và giá trị của chỉ số LDL-C/HDL-C trong dự báo mức độ tổn thương động mạch vành
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu cắt ngang nhằm khảo sát đặc điểm và giá trị của chỉ số LDL-C/HDL-C trong dự báo mức độ tổn thương động mạch vành được đánh giá bằng thang điểm Gensini. Nghiên cứu được thực hiện trên 226 bệnh nhân (tuổi trung bình 64,7 ± 8,0 tuổi, 69% nam giới) bệnh tim thiếu máu cục bộ có tắc nghẽn. Bệnh nhân được chia thành hai nhóm dựa vào trung vị LDL-C/HDL-C: thấp (≤ 2,11) và cao (> 2,11). Tỉ lệ LDL-C/HDL-C liên quan đến BMI, đái tháo đường, rối loạn lipid máu, cholesterol toàn phần, HDL-C, triglyceride, điều trị statin hoặc statin + ezetimibe và điểm Gensini (tất cả p < 0,05). LDL-C/HDL-C có tương quan thuận với điểm Gensini (r = 0,34; p < 0,001). Diện tích dưới đường cong ROC của LDL-C/HDL-C trong dự báo điểm Gensini cao là 0,633 với điểm cắt > 1,91, độ nhạy 76,9%, độ đặc hiệu 47,7%. Phân tích hồi quy đa biến cho thấy LDL-C/HDL-C là yếu tố độc lập dự báo điểm Gensini cao (tỉ số chênh 2,5; p = 0,015). Chỉ số LDL-C/HDL-C liên quan đến các yếu tố nguy cơ tim mạch truyền thống và mức độ tổn thương động mạch vành, đóng vai trò quan trọng trong phân tầng nguy cơ và tiến triển bệnh động mạch vành.
Chi tiết bài viết
Từ khóa
Bệnh tim thiếu máu cục bộ có tắc nghẽn, LDL-C/HDL-C, tổn thương động mạch vành, thang điểm Gensini
Tài liệu tham khảo
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31. Wu TT, Gao Y, Zheng YY, et al. Atherogenic index of plasma (AIP): A novel predictive indicator for the coronary artery disease in postmenopausal women. Lipids Health Dis. 2018; 17(1): 1-7. doi:10.1186/s12944-018-0828-z.
2. Laslett LJ, Alagona P, Clark BA, et al. The worldwide environment of cardiovascular disease: prevalence, diagnosis, therapy, and policy issues: a report from the American College of Cardiology. J Am Coll Cardiol. 2012; 60(25 SUPPL.): S1-49. doi:10.1016/j.jacc.2012.11.002.
3. Forouzanfar MH, Alexander L, Bachman VF, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 386(10010): 2287-2323. doi:10.1016/S0140-6736(15)00128-2.
4. Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006; 367(9524): 1747-1757. doi:10.1016/S0140-6736(06)68770-9.
5. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Vol 139.; 2019. doi:10.1161/CIR.0000000000000659.
6. François Mach, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41(1): 111?188. doi:10.1093/eurheartj/ehz455.
7. Bergheanu SC, Bodde MC, Jukema JW. Pathophysiology and treatment of atherosclerosis: Current view and future perspective on lipoprotein modification treatment. Netherlands Hear J. 2017; 25(4): 231-242. doi:10.1007/s12471-017-0959-2.
8. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022; 80(14): 1366-1418. doi:10.1016/j.jacc.2022.07.006.
9. Sun T, Chen M, Shen H, et al. Predictive value of LDL/HDL ratio in coronary atherosclerotic heart disease. BMC Cardiovasc Disord. 2022; 22(1): 1-11. doi:10.1186/s12872-022-02706-6.
10. Gao P, Wen X, Ou Q, et al. Which one of LDL-C /HDL-C ratio and non-HDL-C can better predict the severity of coronary artery disease in STEMI patients. BMC Cardiovasc Disord. 2022; 22(1): 1-7. doi:10.1186/s12872-022-02760-0.
11. Hu S, Fan H, Zhang S, et al. Association of LDL-C/HDL-C ratio with coronary heart disease: A meta-analysis. Indian Heart J. 2024; 76(2): 79-85. doi:10.1016/j.ihj.2024.01.014.
12. Yuan S, Huang X, Ma W, et al. Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: A longitudinal study based on 384 093 participants from the UK Biobank. Stroke Vasc Neurol. 2023; 8(2): 119-126. doi:10.1136/svn-2022-001668.
13. Bộ Y tế. Thực hành chẩn đoán và điều trị bệnh động mạch vành; 2020.
14. Neumann FJ, Sechtem U, Banning AP, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407-477. doi:10.1093/eurheartj/ehz425.
15. Tamis-Holland JE, Jneid H, Reynolds HR, et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019; 139(18): E891-E908. doi:10.1161/CIR.0000000000000670.
16. Leipsic J, Abbara S, Achenbach S, et al. SCCT Guidelines SCCT guidelines for the interpretation and reporting of coronary CT angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr. 2014; 8(5): 342-358. doi:10.1016/j.jcct.2014.07.003.
17. Lawton JS, Tamis-holland JE, Bangalore S, et al. 2021 ACC / AHA / SCAI Guideline for Coronary Artery Revascularization : Executive Summary: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145(3): e4-e17. doi:10.1161/CIR.0000000000001039.
18. Rampidis GP, Benetos G, Benz DC, et al. A guide for Gensini Score calculation. Atherosclerosis. 2019; 287: 181-183. doi:10.1016/j.atherosclerosis.2019.05.012.
19. Hội Tim mạch Học Quốc gia Việt Nam. Khuyến Cáo về Chẩn Đoán và Điều Trị Tăng Huyết Áp 2018; 2018.
20. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021-3104. doi:10.1097/HJH.
21. American Diabetes Association. Standards of Medical Care in Diabetes-2022 Abridged for Primary Care Providers. Clin Diabetes. 2022; 50(1): 10-38. doi:10.2337/cd17-0119.
22. Parascandola M, Augustson E, Rose A. Characteristics of current and recent former smokers associated with the use of new potential reduced-exposure tobacco products. Nicotine Tob Res. 2009; 11(12): 1431-1438. doi:10.1093/ntr/ntp157.
23. Đặng VP, Phạm TD, Vũ ĐH. Khuyến cáo 2008 của Hội Tim mạch học Việt Nam về chẩn đoán và điều trị rối loạn lipid máu. Khuyến Cáo Năm 2008 về Các Bệnh Lý Tim Mạch và Chuyển Hóa; 2008.
24. Kavey REW, Daniels SR, Lauer RM, et al. American Heart Association guidelines for primary prevention of atherosclerotic cardiovascular disease beginning in childhood. Circulation. 2003; 107(11): 1562-1566. doi:10.1161/01.CIR.0000061521.15730.6E.
25. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3:1-150.
26. Michos ED, Choi AD. Coronary Artery Disease in Young Adults: A Hard Lesson But a Good Teacher. J Am Coll Cardiol. 2019; 74(15): 1879-1882. doi:10.1016/j.jacc.2019.08.1023.
27. Xu J, Chen J, Liu Y, et al. The effect of LDL‑C/HDL‑C ratio on severity of coronary artery disease and 2‑year outcome in patients with premature coronary heart disease: results of a prospective, multicenter, observational cohort study. Eur Heart J. 2023; 44 (Suppl 2): ehad655.1441. doi:10.3760/cma.j.cn112148-20230128-00043.
28. Zhong Z, Hou J, Zhang Q, et al. Assessment of the LDL-C/HDL-C ratio as a predictor of one year clinical outcomes in patients with acute coronary syndromes after percutaneous coronary intervention and drug-eluting stent implantation. Lipids Health Dis. 2019; 18(1): 1-8. doi:10.1186/s12944-019-0979-6.
29. Barter P, Genest J. HDL cholesterol and ASCVD risk stratification: A debate. Atherosclerosis. 2019; 283: 7-12. doi:10.1016/j.atherosclerosis.2019.01.001.
30. Cai G, Shi G, Xue S, et al. The atherogenic index of plasma is a strong and independent predictor for coronary artery disease in the Chinese Han population. Med (United States). 2017; 96(37): 1-6. doi:10.1097/MD.0000000000008058.
31. Wu TT, Gao Y, Zheng YY, et al. Atherogenic index of plasma (AIP): A novel predictive indicator for the coronary artery disease in postmenopausal women. Lipids Health Dis. 2018; 17(1): 1-7. doi:10.1186/s12944-018-0828-z.