Mild Malnutrition Contributes the Greatest to the Poor Prognosis in Coronary Artery Disease With Well-Controlled Low-Density Lipoprotein Cholesterol Levels: A 4,863 Chinese Cohort Study

Bo Wang, Zhaodong Guo, Jin Liu, Huanqiang Li, Ziling Mai, Feng Lin, Ming Ying, Yaren Yu, Shiqun Chen, Qiang Li, Haozhang Huang, Wen Wei, Yongquan Yang, Shaohong Dong, Yingling Zhou, Jiyan Chen, Ning Tan, Yong Liu, Bo Wang, Zhaodong Guo, Jin Liu, Huanqiang Li, Ziling Mai, Feng Lin, Ming Ying, Yaren Yu, Shiqun Chen, Qiang Li, Haozhang Huang, Wen Wei, Yongquan Yang, Shaohong Dong, Yingling Zhou, Jiyan Chen, Ning Tan, Yong Liu

Abstract

Background: Previous studies reported that patients with coronary artery disease (CAD) and well-controlled baseline LDL-C (<1.8 mmol/L) still had higher long-term all-cause mortality. However, no study has been conducted to explore the independent risk factors for long-term mortality. In addition, there also was no study evaluating the population attributable risk (PAR) of independent risk factors in combination with their prevalence and relative risk. Therefore, we aimed to identify the independent risk factors and estimate their PAR in patients with CAD and well-controlled baseline LDL-C (<1.8 mmol/L). Methods: We analyzed 4,863 consecutive CAD patients with well-controlled baseline LDL-C admitted to Guangdong Provincial People's Hospital in China from January 2007 to December 2018. Independent risk factors for long-term all-cause death were evaluated through stepwise approach and multivariable Cox regression analysis. PAR of independent risk factors was calculated with their hazard ratio and prevalence among our cohort. Results: The overall mortality was 16.00% (n = 778) over a median follow-up period of 5.93 years. Independent risk factors for all-cause death included malnutrition, age ≥75 years, congestive heart failure (CHF), chronic kidney disease (CKD) and atrial fibrillation. Among these risk factors of interest, the hazard ratio (HR) of severe malnutrition was the highest (HR 2.82, 95% CI: 1.86-4.26), and the PAR of mild malnutrition was the highest (19.49%, 95% CI: 0.65-36.01%). Conclusion: Malnutrition, age ≥75 years, CHF, CKD and atrial fibrillation were independent predictors for long-term all-cause mortality in CAD patients with well-controlled LDL-C levels. Considering prevalence of these risk factors, more attention should be paid to the occurrence of mild malnutrition for these patients. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04407936.

Keywords: coronary artery disease; long-term all-cause mortality; low-density lipoprotein cholesterol; mild nutrition; population attributable risk; risk factor.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Wang, Guo, Liu, Li, Mai, Lin, Ying, Yu, Chen, Li, Huang, Wei, Yang, Dong, Zhou, Chen, Tan and Liu.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Correlations between LDL-C and nutritional status and its components. Nutritional status is assessed by Controlling Nutritional Status (CONUT) score. Total cholesterol, lymphocyte count and albumin are components of CONUT score. *p-value for spearman correlation >0.05.
Figure 3
Figure 3
Population attributable risk of the independent risk factors of long-term all-cause mortality. PAR, population attributable risk; CI, confidence interval; CHF, congestive heart failure; CKD, chronic kidney disease.

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