使用脂蛋白(a)校正弗瑞德瓦尔德公式是否会改变我们对缺血性心脏病风险的估计？魁北克心血管研究。

Does correction of the friedewald formula using lipoprotein(a) change our estimation of ischemic heart disease risk? The Quebec Cardiovascular Study.

作者信息

Cantin Bernard, Lamarche Benoît, Després Jean-Pierre, Dagenais Gilles R

机构信息

Quebec Heart Institute, Laval University, Canada.

出版信息

Atherosclerosis. 2002 Aug;163(2):261-7. doi: 10.1016/s0021-9150(02)00034-5.

DOI:10.1016/s0021-9150(02)00034-5

PMID:12052472

Abstract

BACKGROUND

LDL-cholesterol is usually calculated using the Friedewald formula. This calculation method does not take into account the presence of Lp(a), which is associated with LDL-cholesterol. Dahlen has suggested that the Friedewald formula should be modified to account for Lp(a) associated cholesterol. This study was undertaken to determine if correction of the Friedewald formula would result in a better evaluation of ischemic heart disease (IHD) risk.

METHODS

2222 men free from IHD were prospectively followed for 5 years for the appearance of myocardial infarction, coronary insufficiency or coronary death. At the baseline evaluation all had a complete fasting lipid profile which included Lp(a) determinations. LDL-cholesterol levels were calculated from total cholesterol, total triglycerides and HDL-cholesterol using the Friedewald formula and also using the Dahlen modification of the Friedewald formula.

RESULTS

During the follow-up there were 89 first IHD events. Both types of LDL-cholesterol calculations showed that the last tertile of the LDL-cholesterol distribution in comparison to the first tertile, doubles the relative risk (RR: 2.15; 95% confidence limits: 1.23-3.75) using the Friedewald formula (RR: 2.18; 95% confidence limits: 1.25-3.81) using the Dahlen modification. Lp(a) levels were not an independent predictor of IHD risk.

CONCLUSION

Modification of the Friedewald formula to account for Lp(a) levels does not improve our evaluation of IHD risk.

摘要

背景

低密度脂蛋白胆固醇（LDL-胆固醇）通常使用弗瑞德沃德公式计算。这种计算方法未考虑与LDL-胆固醇相关的脂蛋白(a) [Lp(a)] 的存在。达伦曾建议应修改弗瑞德沃德公式以纳入与Lp(a) 相关的胆固醇。本研究旨在确定修正后的弗瑞德沃德公式是否能更好地评估缺血性心脏病（IHD）风险。

方法

对2222名无IHD的男性进行了为期5年的前瞻性随访，观察心肌梗死、冠状动脉供血不足或冠状动脉死亡情况。在基线评估时，所有人都进行了完整的空腹血脂检查，包括Lp(a) 测定。使用弗瑞德沃德公式以及弗瑞德沃德公式的达伦修正版，根据总胆固醇、总甘油三酯和高密度脂蛋白胆固醇计算LDL-胆固醇水平。

结果

在随访期间，发生了89例首次IHD事件。两种LDL-胆固醇计算方法均显示，与第一个三分位数相比，LDL-胆固醇分布的最后一个三分位数使相对风险加倍（使用弗瑞德沃德公式时相对风险RR为2.15；95%置信区间：1.23 - 3.75；使用达伦修正版时RR为2.18；95%置信区间：1.25 - 3.81）。Lp(a) 水平不是IHD风险的独立预测因素。