Correlation analysis of lipid metabolism index, serum γ -glutamyltranspeptidase and coronary heart disease complicated with coronary calcification

doi:10.11958/20252178

Abstract

Abstract:

Objective To analyze the correlation between lipid metabolism indexes, serum gamma-glutamyl transpeptidyase (γ-GGT) and coronary heart disease (CHD) complicated with coronary artery calcification (CAC). Methods A total of 300 CHD patients admitted in this study were divided into the CAC group (n=193) and the non-CAC group (n=107). Clinical data of the two groups were compared, including high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), Apolipoprotein A1 (Apo-A1), Apo-B (APO-B) and γ-GGT. The influencing factors of CAC were analyzed by multiple Logistic factors. And a nomogram prediction model was established. Results The basic data of the two groups were compared. Patients of the CAC group was older, had higher proportion of patients with hypertension and diabetes, had higher levels of LDL-C, TC, Apo-B and γ-GGT and lower level of Apo-A1 than those of the non-CAC group (P<0.05). The results of Logistic multivariate regression analysis showed that advanced age, combined history of diabetes, elevated LDL-C, TC, Apo-B and γ-GGT were risk factors of CHD complicated with CAC, while elevated Apo-A1 was the protective factor of CHD complicated with CAC (P<0.05). The AUC of the constructed nomogram model was 0.880 (95%CI:0.840-0.919), which showed good distinguishing ability. Conclusion CHD complicated with CAC is related to lipid metabolism and γ-GGT level. The nomogram model constructed based on influencing factors can be used for clinical early warning of CAC risk.

Key words: coronary disease, vascular calcification, coronary vessels, dyslipidemias, gamma-glutamyltransferase, nomograms

CLC Number:

R541.4

Figures/Tables 6

References 31

[1]	IN CHINA TWCOTROCHAD, HU S S. Report on cardiovascular health and diseases in China 2021: an updated summary[J]. J Geriatr Cardiol, 2023, 20(6):399-430. doi:10.26599/1671-5411.2023.06.001.
[2]	SHAYA G E, LEUCKER T M, JONES S R, et al. Coronary heart disease risk:low-density lipoprotein and beyond[J]. Trends Cardiovasc Med, 2022, 32(4):181-194. doi:10.1016/j.tcm.2021.04.002.
[3]	刘首宏, 张永全, 王俏. 纤维胶凝蛋白与冠状动脉狭窄程度相关性及其对预后的影响[J]. 天津医药, 2023, 51(7):776-780.
	LIU S H, ZHANG Y Q, WANG Q. Correlation between serum ficolin and coronary artery stenosis and its influence on prognosis in patients with coronary heart disease[J]. Tianjin Med J, 2023, 51(7):776-780. doi:10.11958/20221707.
[4]	ONNIS C, VIRMANI R, KAWAI K, et al. Coronary artery calcification:current concepts and clinical implications[J]. Circulation, 2024, 149(3):251-266. doi:10.1161/CIRCULATIONAHA.123.065657.
[5]	SCHÆFFER M, RASMUSSEN J H, FREDGART M H, et al. Coronary artery calcification score and 19 biomarkers on cardiovascular events;a 10-year follow-up DanRisk substudy[J]. Atheroscler Plus, 2024, 58:9-15. doi:10.1016/j.athplu.2024.09.003.
[6]	CONTOIS J H, LANGLOIS M R, COBBAERT C, et al. Standardization of apolipoprotein B,LDL-cholesterol,and non-HDL-cholesterol[J]. J Am Heart Assoc, 2023, 12(15):e030405. doi:10.1161/JAHA.123.030405.
[7]	SUN W, YAMAGISHI K, ISO H. Current status of low-density lipoprotein cholesterol and cardiovascular diseases in Japan[J]. J Atheroscler Thromb, 2023, 30(5):432-433. doi:10.5551/jat.ED217.
[8]	DUPARC T, RUIDAVETS J B, GENOUX A, et al. Serum level of HDL particles are independently associated with long-term prognosis in patients with coronary artery disease:the GENES study[J]. Sci Rep, 2020, 10(1):8138. doi:10.1038/s41598-020-65100-2.
[9]	郝俊文, 夏斌, 席镇, 等. ApoB、ApoA1、ApoA1/ApoB与急性心肌梗死病人CABG术后主要心血管不良事件的相关性[J]. 中西医结合心脑血管病杂志, 2024, 22(4):691-694.
	HAO J W, XIA B, XI Z, et al. The correlation between ApoB,ApoA1,ApoA1/ApoB and major cardiovascular adverse events after CABG in patients with acute myocardial infarction[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease, 2024, 22(4):691-694. doi:10.12102/j.issn.1672-1349.2024.04.021.
[10]	XUAN C, LI J, LIU R H, et al. Association between serum gamma-glutamyltransferase and early-onset coronary artery disease:a retrospective case-control study[J]. Ann Med, 2023, 55(2):2289606. doi:10.1080/07853890.2023.2289606.
[11]	颜红兵. 临床冠心病诊断与治疗指南[M]. 北京: 人民卫生出版社, 2010:5-26.
	YAN H B. Guidelines for clinical diagnosis and treatment of coronary heart disease[M]. Beijing: People's Medical Publishing House, 2010:5-26.
[12]	CLARKE R, VON ENDE A, SCHMIDT L E, et al. Apolipoprotein proteomics for residual lipid-related risk in coronary heart disease[J]. Circ Res, 2023, 132(4):452-464. doi:10.1161/CIRCRESAHA.122.321690.
[13]	AL-SUHAIMI E A, AL-RUBAISH A A. Interplay of serum biomarkers bilirubin and γ-glutamyltranspeptidase in predicting cardiovascular complications in type-2 diabetes mellitus[J]. World J Diabetes, 2024, 15(6):1074-1078. doi:10.4239/wjd.v15.i6.1074.
[14]	石丽媛, 孙静, 荆飞闯. 冠心病合并冠状动脉钙化的影响因素及列线图预测模型建立[J]. 安徽医药, 2023, 27(12):2447-2451.
	SHI L Y, SUN J, JING F C. Influencing factors of coronary heart disease complicated with coronary artery calcification and the establishment of a nomogram prediction model[J]. Anhui Medical and Pharmaceutical Journal, 2023, 27(12):2447-2451. doi:10.3969/j.issn.1009-6469.2023.12.025.
[15]	INOUE K, SEEMAN T E, HORWICH T, et al. Heterogeneity in the association between the presence of coronary artery calcium and cardiovascular events:a machine-learning approach in the MESA Study[J]. Circulation, 2023, 147(2):132-141. doi:10.1161/CIRCULATIONAHA.122.062626.
[16]	SÁNCHEZ-CABO F, FUSTER V, SILLA-CASTRO J C, et al. Subclinical atherosclerosis and accelerated epigenetic age mediated by inflammation:a multi-omics study[J]. Eur Heart J, 2023, 44(29):2698-2709. doi:10.1093/eurheartj/ehad361.
[17]	宋小青, 时士伟, 时金凤. 不同年龄急性冠脉综合征患者临床、CCTA特点及近期预后分析[J]. 中国CT和MRI杂志, 2023, 21(10):109-111,141.
	SONG X Q, SHI S W, SHI J F. Clinical characteristics,CCTA characteristics and short-term prognosis of patients with acute coronary syndrome at different ages[J]. Chinese Journal of CT and MRI, 2023, 21(10):109-111,141. doi:10.3969/j.issn.1672-5131.2023.10.033.
[18]	LORENZATTI D, PIÑA P, HUANG D, et al. Interaction between risk factors,coronary calcium, and CCTA plaque characteristics in patients aged 18-45 years[J]. Eur Heart J Cardiovasc Imaging, 2024, 25(8):1071-1082. doi:10.1093/ehjci/jeae094.
[19]	TANG X, QIAN H, LU S, et al. Predictive nomogram model for severe coronary artery calcification in end-stage kidney disease patients[J]. Ren Fail, 2024, 46(2):2365393. doi:10.1080/0886022X.2024.2365393.
[20]	LIS P, RAJZER M, KLIMA Ł. The significance of coronary artery calcification for percutaneous coronary interventions[J]. Healthcare (Basel), 2024, 12(5):520. doi:10.3390/healthcare12050520.
[21]	GADDE K M, YIN X, GOLDBERG R B, et al. Coronary artery calcium and cognitive decline in the diabetes prevention program outcomes study[J]. J Am Heart Assoc, 2023, 12(21):e029671. doi:10.1161/JAHA.123.029671.
[22]	安娜, 张明健, 牛利, 等. 2型糖尿病患者冠状动脉钙化与骨代谢指标的相关性研究[J]. 中国骨质疏松杂志, 2023, 29(8):1141-1146.
	AN N, ZHANG M J, NIU L, et al. Correlation between coronary artery calcification and bone metabolic markers in patients with type 2 diabetes[J]. Chinese Journal of Osteoporosis, 2023, 29(8):1141-1146. doi:10.3969/j.issn.1006-7108.2023.08.008.
[23]	DU J, WU W, ZHU B, et al. Recent advances in regulating lipid metabolism to prevent coronary heart disease[J]. Chem Phys Lipids, 2023, 255:105325. doi:10.1016/j.chemphyslip.2023.105325.
[24]	MORTENSEN M B, DZAYE O, BØTKER H E, et al. Low-density lipoprotein cholesterol is predominantly associated with atherosclerotic cardiovascular disease events in patients with evidence of coronary atherosclerosis:the Western Denmark Heart Registry[J]. Circulation, 2023, 147(14):1053-1063. doi:10.1161/CIRCULATIONAHA.122.061010.
[25]	赵丹丹, 赵华云, 何明丰, 等. 血瘀型冠心病患者冠脉病变情况与Apo-B和Apo-A1比值的相关性[J]. 广州中医药大学学报, 2023, 40(9):2136-2140.
	ZHAO D D, ZHAO H Y, HE M F, et al. Correlation between coronary artery lesions and the ratio of apo-B and apo-A1 in patients with coronary heart disease of blood stasis type[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2023, 40(9):2136-2140. doi:10.13359/j.cnki.gzxbtcm.2023.09.002.
[26]	GLEASON B, CHISARI E, PARVIZI J. Osteoarthritis can also start in the gut:the gut-joint axis[J]. Indian J Orthop, 2022, 56(7):1150-1155. doi:10.1007/s43465-021-00473-8.
[27]	ARNOLD N, BLAUM C, GOßLING A, et al. Impact of lipoprotein(a) level on low-density lipoprotein cholesterol- or apolipoprotein b-related risk of coronary heart disease[J]. J Am Coll Cardiol, 2024, 84(2):165-177. doi:10.1016/j.jacc.2024.04.050.
[28]	YANG G, MASON A M, WOOD A M, et al. Dose-response associations of lipid traits with coronary artery disease and mortality[J]. JAMA Netw Open, 2024, 7(1):e2352572. doi:10.1001/jamanetworkopen.2023.52572.
[29]	涂诗琴, 高凌云. Non-HDL-C水平和ApoB/ApoA1比值与初发心肌梗死的相关性研究[J]. 中国循证心血管医学杂志, 2024, 16(4):436-440.
	TU S Q, GAO L Y. Correlation among non-high-density lipoprotein-cholesterol,apolipoprotein B/apolipoprotein A1 ratio and incipient acute myocardial infarction[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine, 2024, 16(4):436-440. doi:10.3969/j.issn.1674-4055.2024.04.11.
[30]	杨瑞霞, 顾明. 血清PTX-3、γ-GGT与冠心病及冠脉狭窄程度的相关性分析[J]. 北华大学学报(自然科学版), 2023, 24(5):613-616.
	YANG R X, GU M. Correlation analysis of serum PTX-3 and γ-GGT with coronary heart disease and severity of coronary artery stenosis[J]. Journal of Beihua University(Natural Science), 2023, 24(5):613-616. doi:10.11713/j.issn.1009-4822.2023.05.009.
[31]	ISMAIL Q M, PRASAD M K, MARANDI S, et al. Serum gamma-glutamyl transferase level as a risk factor in acute stroke[J]. J Family Med Prim Care, 2023, 12(12):3172-3179. doi:10.4103/jfmpc.jfmpc_750_23.

组别	n	男性	年龄/岁	BMI/（kg/m²）	CHD病程/年	高血压	糖尿病	吸烟
非CAC组	107	57（53.27）	58.56±9.29	22.45±2.13	1.26±0.26	41（38.32）	34（31.78）	44（41.12）
CAC组	193	102（52.85）	66.74±11.23	22.67±2.26	1.28±0.23	103（53.37）	121（62.69）	82（42.49）
χ²或t		0.005	6.417^＊＊	0.822	0.366	6.247^＊	26.351^＊＊	0.053
组别	饮酒	HDL-C/（mmol/L）	LDL-C/（mmol/L）	TC/ （mmol/L）	TG/ （mmol/L）	Apo-A1/（g/L）	Apo-B/ （g/L）	γ-GGT/（U/L）
非CAC组	38（35.51）	1.23±0.34	2.49±0.61	4.44±1.35	1.83±0.37	1.35±0.21	0.86±0.21	59.77±6.27
CAC组	65（33.68）	1.25±0.37	2.94±0.74	5.23±1.28	1.88±0.41	1.16±0.19	1.24±0.46	68.55±7.63
χ²或t	0.103	0.636	5.346^＊＊	5.064^＊＊	1.036	8.067^＊＊	8.186^＊＊	10.145^＊＊

组别	n	男性	年龄/岁	BMI/（kg/m²）	CHD病程/年	高血压	糖尿病	吸烟
非CAC组	107	57（53.27）	58.56±9.29	22.45±2.13	1.26±0.26	41（38.32）	34（31.78）	44（41.12）
CAC组	193	102（52.85）	66.74±11.23	22.67±2.26	1.28±0.23	103（53.37）	121（62.69）	82（42.49）
χ²或t		0.005	6.417^＊＊	0.822	0.366	6.247^＊	26.351^＊＊	0.053
组别	饮酒	HDL-C/（mmol/L）	LDL-C/（mmol/L）	TC/ （mmol/L）	TG/ （mmol/L）	Apo-A1/（g/L）	Apo-B/ （g/L）	γ-GGT/（U/L）
非CAC组	38（35.51）	1.23±0.34	2.49±0.61	4.44±1.35	1.83±0.37	1.35±0.21	0.86±0.21	59.77±6.27
CAC组	65（33.68）	1.25±0.37	2.94±0.74	5.23±1.28	1.88±0.41	1.16±0.19	1.24±0.46	68.55±7.63
χ²或t	0.103	0.636	5.346^＊＊	5.064^＊＊	1.036	8.067^＊＊	8.186^＊＊	10.145^＊＊

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.100	0.022	20.795	<0.001	1.105（1.059~1.154）
高血压	0.791	0.426	3.447	0.063	2.205（0.957~5.080）
糖尿病	1.870	0.476	15.439	<0.001	6.491（2.553~16.500）
LDL-C	0.668	0.314	4.527	0.033	1.951（1.054~3.610）
TC	0.454	0.158	8.249	0.004	1.574（1.155~2.145）
Apo-A1	-5.448	1.183	21.200	<0.001	0.004（0.000~0.044）
Apo-B	3.180	0.660	23.228	<0.001	24.045（6.598~87.631）
γ-GGT	0.199	0.035	33.055	<0.001	1.220（1.140~1.306）
常数项	-20.047	3.616	30.741	<0.001	<0.001

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.100	0.022	20.795	<0.001	1.105（1.059~1.154）
高血压	0.791	0.426	3.447	0.063	2.205（0.957~5.080）
糖尿病	1.870	0.476	15.439	<0.001	6.491（2.553~16.500）
LDL-C	0.668	0.314	4.527	0.033	1.951（1.054~3.610）
TC	0.454	0.158	8.249	0.004	1.574（1.155~2.145）
Apo-A1	-5.448	1.183	21.200	<0.001	0.004（0.000~0.044）
Apo-B	3.180	0.660	23.228	<0.001	24.045（6.598~87.631）
γ-GGT	0.199	0.035	33.055	<0.001	1.220（1.140~1.306）
常数项	-20.047	3.616	30.741	<0.001	<0.001