Youssef A A, Srinivasan S R, Elkasabany A, Chen W, Berenson G S
Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
Metabolism. 2001 Dec;50(12):1441-6. doi: 10.1053/meta.2001.28076.
Although dyslipidemia among offspring of parents with coronary heart disease (CHD) has been known, the development of this adverse relationship with respect to specific lipoprotein variables from childhood to young adulthood has not been elucidated. This aspect was examined in a young adult cohort with (n = 271) and without (n = 805) a parental history of CHD followed longitudinally since childhood by repeated surveys from 1973 to 1991. Trends in fasting lipoprotein variables by parental CHD status were assessed by Lowess smoothing curve and Generalized Estimating Equations (GEE). In multivariate analyses adjusted for race and sex, parental CHD associated positively with low-density lipoprotein cholesterol (LDL-C, P <.01) and triglycerides (P <.05) mainly at the young adulthood age, whereas a positive association was noted with very-low-density lipoprotein cholesterol (VLDL-C) during both childhood and young adulthood (P <.05). The positive association between parental CHD and LDL-C in young adulthood persisted independently of body mass index (BMI) and fasting insulin, but disappeared when fasting glucose was added to the model. With respect to triglycerides and VLDL-C, inclusion of BMI, insulin, and/or glucose eliminated the adverse association with parental CHD. These observations suggest that parental CHD is just one more explanatory variable that loses its partial contribution to lipoprotein profiles in their offspring when other strongly interrelated contributory variables such as age, body fatness, and measures of glucose homeostasis are taken into account. Information on these risk variables in conjunction with parental or family history of CHD may enhance the potential of CHD risk assessment in youth.
虽然冠心病(CHD)患者后代中的血脂异常现象已为人所知,但从儿童期到青年期,这种不良关系在特定脂蛋白变量方面的发展情况尚未阐明。在一个年轻成人队列中对此进行了研究,该队列中有冠心病家族史的有271人,无冠心病家族史的有805人,自儿童期起通过1973年至1991年的多次调查进行纵向跟踪。通过局部加权散点平滑法(Lowess)平滑曲线和广义估计方程(GEE)评估了按父母冠心病状态划分的空腹脂蛋白变量趋势。在针对种族和性别进行调整的多变量分析中,父母患冠心病主要在青年期与低密度脂蛋白胆固醇(LDL-C,P <.01)和甘油三酯(P <.05)呈正相关,而在儿童期和青年期均与极低密度脂蛋白胆固醇(VLDL-C)呈正相关(P <.05)。青年期父母患冠心病与LDL-C之间的正相关在独立于体重指数(BMI)和空腹胰岛素的情况下依然存在,但在模型中加入空腹血糖后这种相关性消失。对于甘油三酯和VLDL-C,纳入BMI、胰岛素和/或血糖后消除了与父母患冠心病的不良关联。这些观察结果表明,父母患冠心病只是另一个解释变量,当考虑到其他如年龄、身体脂肪含量和葡萄糖稳态指标等高度相关的促成变量时,它对其后代脂蛋白谱的部分贡献就会丧失。关于这些风险变量的信息,结合父母或家族冠心病史,可能会提高青年冠心病风险评估的潜力。