张 松,张广玉

残余胆固醇（RC）作为富含甘油三酯的脂蛋白代谢残粒，近年来被证实是动脉粥样硬化性心脑血管疾病的独立危险因素。传统观点认为低密度脂蛋白胆固醇（LDL-C）是的主要致病因素，但研究发现即使LDL-C控制达标，残余胆固醇水平升高仍与心梗、脑卒中等心脑血管事件风险显著相关。本文综述了国内外目前对于残余胆固醇在各类心脑血管事件中的影响以及对于残余胆固醇升高的治疗策略。

残余胆固醇；动脉粥样硬化；心脑血管疾病；治疗策略

[1] Rosenson RS,Shaik A,Song WL.:inar 3/4[J].J Am Coll Cardiol,2021,78(18):1817-1 830. [2] 王增武,刘静,李建军等.中国血脂管理指南(2023)[J].中国循环杂志,2023,38(3):237-271. [3] Zheng WC,Chan W,Dart A,et al.Novel therapeutic targets and emerging treatments for ath eroscle rotic cardiovascular disease.Eur Heart J Cardiovasc Pharmacother.2024 Jan 5;10(1):53-67. [4] Yang XH,Zhang BL,Cheng Y,et al.Association of remnant cholesterol with risk of cardiovascular disease events,stroke,and mortality:A systemic review and meta-analysis.Atherosclerosis.2023 Apr;371:21-31. [5] Baratta F,Cocomello N,Coronati M,et al.Cholesterol Remnants,Triglyceride-Rich Lipoproteins and Cardiovascular Risk.Int J Mol Sci. 2023 Feb 21;24(5):4268. [6] Proctor SD,Wang M,Vine DF,et al.Predictive utility of remnant cholesterol in atheroscl erotic cardiovascular disease.Curr Opin Cardiol.2024 Jul 1;39(4):300-307. [7] Heo JH,Jo SH.Triglyceride-Rich Lipoproteins and Remnant Cholesterol in Cardiovascular Disease.J Korean Med Sci.2023 Sep. 25;38(38):e295. [8] PintóX,Fanlo M,Esteve V,et a.Grupo de Trabajo Dislipemia Aterogénica,Sociedad Españolade Arteriosclerosis(SEA).Remnant cholesterol,vascular risk,and prevention of atherosclerosis.Clin Investig Arterioscler.2023 Jul-Aug;35(4):206-217. [9] Doi T,Nordestgaard BG,Langsted A.Can remnant cholesterol(triglyceride-rich lipoproteins)reclassify estimated risk of at her osclerotic cardiovascular disease?Curr Opin Endocrinol Diabetes Obes.2023 Apr 1;30(2):128-135. [10] Castañer O,PintóX,Subirana I,et al.Remnant Cholesterol,Not LDL Cholesterol,Is Associated With Incident Cardiovascular Disease.J Am Coll Cardiol.2020 Dec 8;76(23):2712-2724. [11] Wadström BN,Pedersen KM,Wulff AB,et al.Elevated remnant cholesterol,plasma triglyce rides,and cardiovascular and non- cardiovascular mortality.Eur Heart J.2023 Apr 21;44(16):1432-1445. [12] Quispe R,Martin SS,Michos ED,et al.Remnant cholesterol predicts cardiovas cular disease beyond LDL and ApoB:a primary prevention study.Eur Heart J.2021 Nov 7;42(42):4324-4332. [13] Guo DC,Gao JW,Wang X,et al.Remnant cholesterol and risk of incident hypertension:a population-based prospective cohort study.Hypertens Res.2024 May;47(5):1157-1166. [14] Zheutlin AR,Chaitoff A.The Association Between Remnant Cholesterol and Blood Pressure:National Health and Nutrition Examination Surveys 2013-2018.Am J Cardiol.2023 Oct 15;20 5:327-328. [15] Chen W,Hu H,Cao C,et al.Link between remnant cholesterol and the reversion to normoglyc emia in Chinese adults with prediabetes:a 5-year cohort study.Sci Rep.2024 Aug 5;14(1):18098. [16] Wang Y,Liu Y,Yang R,et al.Remnant cholesterol for the detection of glucose metabolic states in patients with coronary heart disease angina pectoris.Acta Diabetol.2022 Oct;59(10):1339-1347. [17] Huh JH,Roh E,Lee SJ,et al.Remnant Cholesterol Is an Independent Predictor of Type 2 Diabetes:A Nationwide Population-Based Cohort Study.Diabetes Care.2023 Feb 1;46(2):305-312. [18] Zheng X,Jiang M,Ren X,et al.The longitudinal association of remnant cholesterol with diabetes in middle-aged and elderly Chinese:A nationwide population-based cohort study.J Diabetes Complications.2023 Jan;37(1):108360. [19] Zhao Y,Zhuang Z,Li Y,et al.Elevated blood remnant cholesterol and triglycerides are causally related to the risks of cardiometabolic multimorbidity.Nat Commun.2024 Mar 19;15(1):2451. [20] Jin J,Hu X,Francois M,et al.Association between remnant cholesterol,metabolic syndrome,and cardiovascular disease:post hoc analysis of a prospective national cohort study.Eur J Med Res.2023 Oct 11;28(1):420. [21] Guan B,Wang A,Xu H.Causal associations of remnant cholesterol with cardiometabolic diseases and risk factors:a mendelian randomization analysis.Cardiovasc Diabetol.2023 Aug 10;22(1):207. [22] Zhao X,Wang Y,Li W,et al.Cumulative remnant cholesterol as acausal risk factor for ischemic heart disease:A prospective cohort study.Curr Probl Cardiol.2024 Feb;49(2):102215. [23] Tian Y,Wu W,Qin L,et al.Prognostic value of remnant cholesterol in patients with coronary heart disease:A systematic review and meta-analysis of cohort studies.Front Cardiovasc Med.2023 Jan 19;9:951523. [24] Chen ZT,Guo DC,Gao JW,et al.Low remnant cholesterol and the subsequent risk of new-onset atrial fibrillation:A prospective cohort study.Heart Rhythm.2024 Aug;21(8):1258-1266. [25] Ouyang X,Tang X,Peng L,et al.Remnant cholesterol and new-onset atrial fibrillation:The Atherosclerosis Risk in Communities study.Heart Rhythm.2024 Oct 19:S1547-5271(24)03456-8. [26] Zafrir B,Khoury R,Saliba W.Remnant cholesterol and risk of myocardial infarction in patients with coronary artery disease undergoing revascularization.J Clin Lipidol.2023 May-Jun;17(3):332-341. [27] Liu X,Zhang Y,Tian X,et al.Time course of remnant cholesterol and the risk of heart failure.Endocrine.2024 Sep 21. [28] Yu S,Yan L,Yan J,et al.The predictive value of nontraditional lipid parameters for intracranial and extracranial atherosclerotic stenosis:a hospital-based observational study in China.Lipids Health Dis.2023 Jan 28;22(1):16. [29] Wu S,Su X,Zuo Y,et al.Discordance between remnant cholesterol and low-density lipoprotein cholesterol predicts arterial stiffness progression.Hellenic J Cardiol.2023 Nov-Dec;74:24-31. [30] Jiang X,Zhuang J,Juan Y,et al.Association between remnant cholesterol and the risk of cardiovascular disease in Chinese population.J Stroke Cerebrovasc Dis.2024 Aug;33(8):107825. [31] Han M,Huang K,Shen C,et al.Discordant High Remnant Cholesterol With LDL-C Increases the Risk of Stroke:A Chinese Prospective Cohort Study.Stroke.2024 Aug;55(8):2066-2074. [32] Feng Q,Li H,Zhang RY,et al.Elevated remnant cholesterol is a risk factor for acute ischemic stroke.J Stroke Cerebrovasc Dis.2024 Aug;33(8):107773. [33] Li H,Miao S,Chen L,et al.Association and mediating mechanism between remnant cholesterol and first-ever stroke among the Chinese general population.Front Neurosci.2023 May 25;17:1161367. [34] Li W,Huang Z,Fang W,et al.Remnant Cholesterol Variability and Incident Ischemic Stroke in the General Population.Stroke.2022 Jun;53(6):1934-1941. [35] Tan Z,Zhang Q,Liu Q,et al.Relationship between remnant cholesterol and short-term prognosis in acute ischemic stroke patients.Brain Behav.2024 May;14(5):e3537. [36] Lechner K,von Schacky C,McKenzie AL,et al.Lifestyle factors and high-risk atherosclerosis:Pathways and mechanisms beyond traditional risk factors.Eur J Prev Cardiol.2020 Mar;27(4):394-406. [37] Raggi P,Becciu ML,Navarese EP.Remnant cholesterol as a new lipid-lowering target to reduce cardiovascular events.Curr Opin Lipidol.2024 Jun 1;35(3):110-116. [38] Ascaso JF,Millán J,Hernández-Mijares A,et al.Grupode trabajo sobre Dislipemia At erogénica de la SEA.Atherogenic Dyslipidaemia 2019.Consensus document of the Atherogenic Dyslipidaemia Group of the Spanish Arteriosclerosis Society.Clin Investig Arterioscler.2020 May-Jun;32(3):120-125.English,Spanish. [39] Wang K,Wang R,Yang J,et al.Remnant cholesterol and atherosclerotic cardiovascular disease:Metabolism,mechanism,evidence,and treatment.Front Cardiovasc Med.2022 Oct 17;9:913869. [40] Mach F,Baigent C,Catapano AL,et al.2019ESC/EAS Guidelines for the management of dyslipi daemias:lipid modification to reduce cardiovascular risk:the Task Force for the management ofdyslipida emias of the European Society of Cardiology(ESC)and European Atherosclerosis Societ(EAS).Eur Heart J 2020;41:111–188. [41] Tsunoda F,Asztalos IB,Horvath KV,et al.Fenofibrate,HDL,and cardiovascular disease in Type-2 diabetes:the DAIS trial. Atheros- clerosis.(2016)247:35–9. [42] Ishibashi S,Yamashita S,Arai H,et al.Effects of K-877,a novel selective PPARαmodulator(SPPARMα),in dyslipidaemic patients:a randomized,double blind,active-and placebo-controlled,phase 2 trial.Atherosclerosis.(2016)249:36–43. [43] Miller PE,Martin SS,Joshi PH,et al.Pitavastatin 4mg provides significantly greater reduction in remnant lipoprotein cholesterol compared with pravastatin 40mg:results from the short-term phase IV PREVAIL US Trial in patients with primary hyperlipidemia or mixed dyslip idemia.Clin Ther 2016;38:603–609. [44] Bhatt DL,Steg PG,Miller M,et al.Cardiovascular risk reduction with icosapent ethyl for hypertr iglyceridemia.N Engl J Med 2019;380:11–22. [45] Tardif JC,Karwatowska-Prokopczuk E,Amour ES,et al.Apolipoprotein C-III reduction in subjects with moderate hypertriglycerida emia and at high car diovascular risk.Eur Heart J 2022;43:1401–1412. [46] Mohamed F,Mansfield BS,Raal FJ.ANGPTL3 as a Drug Target in Hyperlipidemia and Atherosclerosis.Curr Atheroscler Rep.2022 Dec;24(12):959-967.

点击下载PDF