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Mildly Abnormal Lipid Levels, but Not High Lipid Variability, Are Associated with Increased Risk of Myocardial Infarction and Stroke in 'Statin-Naive' Young Population: A Nationwide Cohort Study
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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.

Lipids, young adults, myocardial infarction, stroke, epidemiology.

- 형식: Research article
- 게재일: 2020년 01월 (BRIC 등록일 2020-02-04)
- 연구진: 국내연구진태극기
- 분야: Medicine
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김형관 (서울대학교 의과대학)
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한경도 (가톨릭대학교 의과대학)
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사전접수: ~2020.04.20
날짜: 2020.04.20
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