Journal of clinical lipidology · 2026
The impact of cumulative low-density lipoprotein cholesterol on prognosis in coronary heart disease patients: A retrospective study based on time-weighted cumulative exposure.
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Hu Xiuying, Zhao Yike, Guan Qianglin, Zhong Hongfei, Yang Yue, Chen Yan, Fan Wentao, Ye Xinyan, Qiu Xinyao, Huang Sizhen, Li Zhuoyu, Shao Mengjiao, Chen Jian
Аннотация
BACKGROUND: While lipids are known prognostic markers in coronary heart disease (CHD), the long-term impact of cumulative low-density lipoprotein cholesterol (cum-LDL-C) and the duration of high LDL-C exposure remains unclear.
OBJECTIVE: This study aimed to evaluate their association with major adverse cardiovascular events (MACE) in patients with CHD.
METHODS: We included 1271 patients initially diagnosed with CHD between 2018 and 2023, each with at least 2 follow-up records. Time-weighted cum-LDL-C was calculated and categorized by quartiles (Q1-Q4). Duration of high LDL-C exposure was grouped as 0, 0-2, >2 years. Cox models were used to estimate hazard ratios (HRs) and 95% CIs for MACE, all-cause mortality, and other cardiovascular outcomes. A nomogram was developed for clinical risk scoring.
RESULTS: Over a median follow-up of 1293 days, 196 patients experienced MACE. After multivariable adjustment, the highest cum-LDL-C quartile (Q4) showed significantly increased risks of MACE (HR: 3.50, 95% CI: 2.24-5.47), percutaneous coronary intervention (HR: 3.08, 1.41-6.71), and ischemic stroke (HR: 4.32, 2.25-8.30). Exposure to high LDL-C for >2 years was associated with a 1.68-fold higher MACE risk (95% CI: 1.18-2.40) and a 2.09-fold higher ischemic stroke risk (95% CI: 1.34-3.27). No significant associations were found with all-cause mortality or myocardial infarction.
CONCLUSION: Both elevated cum-LDL-C and prolonged exposure to high LDL-C are associated with increased risks of MACE in patients with CHD. Extending lipid monitoring periods may help clarify cumulative risk and improve clinical management.
OBJECTIVE: This study aimed to evaluate their association with major adverse cardiovascular events (MACE) in patients with CHD.
METHODS: We included 1271 patients initially diagnosed with CHD between 2018 and 2023, each with at least 2 follow-up records. Time-weighted cum-LDL-C was calculated and categorized by quartiles (Q1-Q4). Duration of high LDL-C exposure was grouped as 0, 0-2, >2 years. Cox models were used to estimate hazard ratios (HRs) and 95% CIs for MACE, all-cause mortality, and other cardiovascular outcomes. A nomogram was developed for clinical risk scoring.
RESULTS: Over a median follow-up of 1293 days, 196 patients experienced MACE. After multivariable adjustment, the highest cum-LDL-C quartile (Q4) showed significantly increased risks of MACE (HR: 3.50, 95% CI: 2.24-5.47), percutaneous coronary intervention (HR: 3.08, 1.41-6.71), and ischemic stroke (HR: 4.32, 2.25-8.30). Exposure to high LDL-C for >2 years was associated with a 1.68-fold higher MACE risk (95% CI: 1.18-2.40) and a 2.09-fold higher ischemic stroke risk (95% CI: 1.34-3.27). No significant associations were found with all-cause mortality or myocardial infarction.
CONCLUSION: Both elevated cum-LDL-C and prolonged exposure to high LDL-C are associated with increased risks of MACE in patients with CHD. Extending lipid monitoring periods may help clarify cumulative risk and improve clinical management.