Abstract：
BACKGROUND: The association between free fatty acids (FFAs) and unfavorable clinical outcomes has been reported in the general population. However, evidence in the secondary prevention population is relatively scarce.
OBJECTIVE: We aimed to examine the relationship between FFA and cardiovascular risk in patients with coronary artery disease (CAD).
METHODS: This study was based on a multicenter cohort of patients with CAD enrolled from January 2015 to May 2019. The primary outcome was all-cause death. Secondary outcomes included cardiac death and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, and unplanned revascularization.
RESULTS: During a follow-up of 2 years, there were 468 (3.0%) all-cause deaths, 335 (2.1%) cardiac deaths, and 1279 (8.1%) MACE. Elevated FFA levels were independently associated with increased risks of all-cause death, cardiac death, and MACE (all P < .05). Moreover, When FFA were combined with an original model derived from the Cox regression, there were significant improvements in discrimination and reclassification for prediction of all-cause death (net reclassification improvement [NRI] 0.245, P < .001; integrated discrimination improvement [IDI] 0.004, P = .004), cardiac death (NRI 0.269, P < .001; IDI 0.003, P = .006), and MACE (NRI 0.268, P < .001; IDI 0.004, P < .001). Notably, when stratified by age, we found that the association between FFA with MACE risk appeared to be stronger in patients aged ≥60 years compared with those aged <60 years.
CONCLUSIONS: In patients with CAD, FFAs are associated with all-cause death, cardiac death, and MACE. Combined evaluation of FFAs with other traditional risk factors could help identify high-risk individuals who may require closer monitoring and aggressive treatment.
OBJECTIVE: We aimed to examine the relationship between FFA and cardiovascular risk in patients with coronary artery disease (CAD).
METHODS: This study was based on a multicenter cohort of patients with CAD enrolled from January 2015 to May 2019. The primary outcome was all-cause death. Secondary outcomes included cardiac death and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, and unplanned revascularization.
RESULTS: During a follow-up of 2 years, there were 468 (3.0%) all-cause deaths, 335 (2.1%) cardiac deaths, and 1279 (8.1%) MACE. Elevated FFA levels were independently associated with increased risks of all-cause death, cardiac death, and MACE (all P < .05). Moreover, When FFA were combined with an original model derived from the Cox regression, there were significant improvements in discrimination and reclassification for prediction of all-cause death (net reclassification improvement [NRI] 0.245, P < .001; integrated discrimination improvement [IDI] 0.004, P = .004), cardiac death (NRI 0.269, P < .001; IDI 0.003, P = .006), and MACE (NRI 0.268, P < .001; IDI 0.004, P < .001). Notably, when stratified by age, we found that the association between FFA with MACE risk appeared to be stronger in patients aged ≥60 years compared with those aged <60 years.
CONCLUSIONS: In patients with CAD, FFAs are associated with all-cause death, cardiac death, and MACE. Combined evaluation of FFAs with other traditional risk factors could help identify high-risk individuals who may require closer monitoring and aggressive treatment.
摘要：
背景：已经在普通人群中报道了游离脂肪酸（FFA）与不良临床结局之间的关联。然而,二级预防人群的证据相对较少。
目的：我们旨在研究冠心病患者FFA与心血管风险之间的关系。
方法：本研究基于2015年1月至2019年5月招募的CAD患者的多中心队列。主要结果是全因死亡。次要结局包括心源性死亡和主要不良心血管事件(MACE),死亡的复合，心肌梗塞,和计划外的血运重建。
结果：在2年的随访中，全因死亡人数为468人(3.0%),335例（2.1%）心脏死亡，和1279（8.1%）MACE。FFA水平升高与全因死亡风险增加独立相关，心脏死亡,和MACE（所有P<0.05）。此外，当FFA与从Cox回归得出的原始模型组合时，预测全因死亡的辨别和重新分类有显著改善(净重新分类改善[NRI]0.245,P<.001;综合辨别改善[IDI]0.004,P=.004),心源性死亡（NRI0.269，P<.001；IDI0.003，P=.006），和MACE（NRI0.268，P<.001；IDI0.004，P<.001）。值得注意的是,当按年龄分层时，我们发现,与年龄<60岁的患者相比,≥60岁的患者FFA与MACE风险之间的相关性更强.
结论：在CAD患者中，FFA与全因死亡有关，心脏死亡,和MACE。FFA与其他传统风险因素的联合评估可以帮助识别可能需要密切监测和积极治疗的高危个体。
目的：我们旨在研究冠心病患者FFA与心血管风险之间的关系。
方法：本研究基于2015年1月至2019年5月招募的CAD患者的多中心队列。主要结果是全因死亡。次要结局包括心源性死亡和主要不良心血管事件(MACE),死亡的复合，心肌梗塞,和计划外的血运重建。
结果：在2年的随访中，全因死亡人数为468人(3.0%),335例（2.1%）心脏死亡，和1279（8.1%）MACE。FFA水平升高与全因死亡风险增加独立相关，心脏死亡,和MACE（所有P<0.05）。此外，当FFA与从Cox回归得出的原始模型组合时，预测全因死亡的辨别和重新分类有显著改善(净重新分类改善[NRI]0.245,P<.001;综合辨别改善[IDI]0.004,P=.004),心源性死亡（NRI0.269，P<.001；IDI0.003，P=.006），和MACE（NRI0.268，P<.001；IDI0.004，P<.001）。值得注意的是,当按年龄分层时，我们发现,与年龄<60岁的患者相比,≥60岁的患者FFA与MACE风险之间的相关性更强.
结论：在CAD患者中，FFA与全因死亡有关，心脏死亡,和MACE。FFA与其他传统风险因素的联合评估可以帮助识别可能需要密切监测和积极治疗的高危个体。
