Abstract：
Increased free fatty acid (FFA) levels are known to be strongly associated with mortality in coronary artery disease (CAD) patients and the development of type 2 diabetes (T2DM). However, few studies have been large enough to accurately examine the relationship between FFA levels and mortality in CAD patients with T2DM.
From December 2016 to October 2021, 10 395 CAD patients enrolled in PRACTICE, a prospective cohort study in China, were divided into four groups according to baseline FFA concentration. We investigated mortality, including all-cause mortality (ACM) and cardiac mortality (CM), as the primary endpoint. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse cardiovascular events (MACEs). The median follow-up time was 24 months. In the total cohort, there were 222 ACMs, 164 CMs, 718 MACEs, and 803 MACCEs recorded. After controlling for baseline variables, the association between FFA levels and the risk of mortality presented a non-linear U-shaped curve, with the lowest risk at 310 µmol/L. We also identified a non-linear U-shaped relationship for ischaemic events (MACE or MACCE) with the lowest risk at 500 µmol/L. Subgroup analysis showed that a U-shaped relationship between FFA and mortality or ischaemic events was observed only in individuals with T2DM but not in non-diabetic CAD patients.
A non-linear U-shaped association was identified between baseline FFA levels and mortality or ischaemic events in CAD patients with T2DM.
From December 2016 to October 2021, 10 395 coronary artery disease (CAD) patients enrolled in PRACTICE, a prospective cohort study in China, were divided into four groups according to baseline free fatty acid (FFA) concentration. We investigated mortality, including all-cause mortality (ACM), and cardiac mortality (CM), as the primary endpoints. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse cardiovascular events (MACEs). The median follow-up time was 24 months. Finally, we were surprised to find that high and low FFA levels were associated with a higher risk of mortality and ischaemic events in CAD patients with T2DM. Baseline plasma FFA levels may be a more powerful, effective, and easily detectable biomarker of adverse outcomes in CAD patients with T2DM. As the FFA increases, a U-shaped curve appears in the poor long-term prognosis.
From December 2016 to October 2021, 10 395 CAD patients enrolled in PRACTICE, a prospective cohort study in China, were divided into four groups according to baseline FFA concentration. We investigated mortality, including all-cause mortality (ACM) and cardiac mortality (CM), as the primary endpoint. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse cardiovascular events (MACEs). The median follow-up time was 24 months. In the total cohort, there were 222 ACMs, 164 CMs, 718 MACEs, and 803 MACCEs recorded. After controlling for baseline variables, the association between FFA levels and the risk of mortality presented a non-linear U-shaped curve, with the lowest risk at 310 µmol/L. We also identified a non-linear U-shaped relationship for ischaemic events (MACE or MACCE) with the lowest risk at 500 µmol/L. Subgroup analysis showed that a U-shaped relationship between FFA and mortality or ischaemic events was observed only in individuals with T2DM but not in non-diabetic CAD patients.
A non-linear U-shaped association was identified between baseline FFA levels and mortality or ischaemic events in CAD patients with T2DM.
From December 2016 to October 2021, 10 395 coronary artery disease (CAD) patients enrolled in PRACTICE, a prospective cohort study in China, were divided into four groups according to baseline free fatty acid (FFA) concentration. We investigated mortality, including all-cause mortality (ACM), and cardiac mortality (CM), as the primary endpoints. The secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs) and major adverse cardiovascular events (MACEs). The median follow-up time was 24 months. Finally, we were surprised to find that high and low FFA levels were associated with a higher risk of mortality and ischaemic events in CAD patients with T2DM. Baseline plasma FFA levels may be a more powerful, effective, and easily detectable biomarker of adverse outcomes in CAD patients with T2DM. As the FFA increases, a U-shaped curve appears in the poor long-term prognosis.
摘要：
目的：已知游离脂肪酸（FFA）水平升高与冠状动脉疾病（CAD）患者的死亡率和2型糖尿病（T2DM）的发展密切相关。然而,很少有足够大的研究来准确检查2型糖尿病CAD患者FFA水平与死亡率之间的关系.
方法：从2016年12月至2021年10月，10395名CAD患者参加了实践，在中国进行的前瞻性队列研究，根据基线FFA浓度分为四组。我们调查了死亡率,包括全因死亡率（ACM）和心脏死亡率（CM），作为主端点。次要终点是主要不良心脑血管事件（MACCEs）和主要不良心血管事件（MACEs）。中位随访时间为24个月。
结果：在总队列中，有222个ACM，164个CM，记录了718个MACE和803个MACCE。在控制基线变量后，FFA水平与死亡风险之间的关系呈现非线性U形曲线，风险最低，为310μmol/L。我们还确定了缺血性事件（MACE或MACCE）的非线性U形关系，在500µmol/L时风险最低。亚组分析显示，FFA与死亡率或缺血事件之间的U型关系仅在T2DM患者中观察到，而在非糖尿病CAD患者中没有观察到。
结论：在有T2DM的CAD患者中，基线FFA水平与死亡率或缺血事件之间存在非线性U型关联。
从2016年12月到2021年10月，10395名冠状动脉疾病（CAD）患者参加了实践，在中国进行的前瞻性队列研究，根据基线游离脂肪酸（FFA）浓度分为四组。我们调查了死亡率,包括全因死亡率（ACM）和心脏死亡率（CM），作为主要终点。次要终点是主要不良心脑血管事件（MACCEs）和主要不良心血管事件（MACEs）。中位随访时间为24个月。最后,我们惊讶地发现,在有T2DM的CAD患者中,高和低FFA水平与较高的死亡和缺血事件风险相关.基线血浆FFA水平可能更强大，2型糖尿病CAD患者不良结局的有效且易于检测的生物标志物。随着FFA的增加，长期预后不良时出现U型曲线。
方法：从2016年12月至2021年10月，10395名CAD患者参加了实践，在中国进行的前瞻性队列研究，根据基线FFA浓度分为四组。我们调查了死亡率,包括全因死亡率（ACM）和心脏死亡率（CM），作为主端点。次要终点是主要不良心脑血管事件（MACCEs）和主要不良心血管事件（MACEs）。中位随访时间为24个月。
结果：在总队列中，有222个ACM，164个CM，记录了718个MACE和803个MACCE。在控制基线变量后，FFA水平与死亡风险之间的关系呈现非线性U形曲线，风险最低，为310μmol/L。我们还确定了缺血性事件（MACE或MACCE）的非线性U形关系，在500µmol/L时风险最低。亚组分析显示，FFA与死亡率或缺血事件之间的U型关系仅在T2DM患者中观察到，而在非糖尿病CAD患者中没有观察到。
结论：在有T2DM的CAD患者中，基线FFA水平与死亡率或缺血事件之间存在非线性U型关联。
从2016年12月到2021年10月，10395名冠状动脉疾病（CAD）患者参加了实践，在中国进行的前瞻性队列研究，根据基线游离脂肪酸（FFA）浓度分为四组。我们调查了死亡率,包括全因死亡率（ACM）和心脏死亡率（CM），作为主要终点。次要终点是主要不良心脑血管事件（MACCEs）和主要不良心血管事件（MACEs）。中位随访时间为24个月。最后,我们惊讶地发现,在有T2DM的CAD患者中,高和低FFA水平与较高的死亡和缺血事件风险相关.基线血浆FFA水平可能更强大，2型糖尿病CAD患者不良结局的有效且易于检测的生物标志物。随着FFA的增加，长期预后不良时出现U型曲线。
