Mackey Rachel H, Kuller Lewis H, Sutton-Tyrrell Kim, Evans Rhobert W, Holubkov Richard, Matthews Karen A
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Am J Cardiol. 2002 Oct 17;90(8A):71i-76i. doi: 10.1016/s0002-9149(02)02636-x.
Lipoprotein subclass levels may improve the prediction of cardiovascular disease (CAD) in individuals beyond the risk assessment provided by conventional enzymatically determined lipid levels. The objective of this study was to evaluate the associations between nuclear magnetic resonance (NMR) spectroscopy-determined lipoprotein subclasses and coronary calcification in postmenopausal women, and to determine whether the associations were independent of conventional lipid measures. Coronary artery calcification (CAC) was measured by electron beam computed tomography, and lipoprotein subclasses were determined by NMR spectroscopy (Liposcience, Inc., Raleigh, NC), in 286 healthy women (mean age = 61.7), at 8 years postmenopause. CAC was analyzed as categories 0, 1 to 99, and > or =100. The mean CAC was 53 (range, 0 to 1,175), and 54% of the women had 0 scores. Large high-density lipoprotein (HDL) was inversely associated with CAC category, but small HDL was not. All very low-density lipoprotein (VLDL) subclasses-small, medium, and large-were positively associated with CAC (p <0.01). Small low-density lipoprotein (LDL) was positively associated with CAC (p <0.01), but medium and large LDL were not. Smaller LDL particle size (p <0.01) and higher levels of LDL particles (p <0.001) were associated with higher CAC category. In separate ordinal logistic regression models, small LDL, LDL particles, and large VLDL were each positively associated (p <0.05) with higher CAC after adjustment for age, systolic blood pressure (SBP), current smoking, and conventional measures of LDL cholesterol, HDL cholesterol, and triglycerides. These results suggest that the measurement of lipoprotein subclasses may improve the prediction of CAD in postmenopausal women beyond that provided by the conventional lipid panel and CAD risk factors.
脂蛋白亚类水平或许能在传统酶法测定的血脂水平所提供的风险评估之外,进一步改善对个体心血管疾病(CAD)的预测。本研究的目的是评估绝经后女性中通过核磁共振(NMR)光谱法测定的脂蛋白亚类与冠状动脉钙化之间的关联,并确定这些关联是否独立于传统血脂指标。通过电子束计算机断层扫描测量冠状动脉钙化(CAC),并采用NMR光谱法(Liposcience公司,北卡罗来纳州罗利市)测定286名健康绝经后女性(平均年龄 = 61.7岁)的脂蛋白亚类。CAC被分析为0、1至99以及≥100这几类。平均CAC为53(范围为0至1175),54%的女性得分为0。大颗粒高密度脂蛋白(HDL)与CAC类别呈负相关,但小颗粒HDL并非如此。所有极低密度脂蛋白(VLDL)亚类——小、中、大颗粒——均与CAC呈正相关(p <0.01)。小颗粒低密度脂蛋白(LDL)与CAC呈正相关(p <0.01),但中颗粒和大颗粒LDL并非如此。较小的LDL颗粒大小(p <0.01)和较高的LDL颗粒水平(p <0.001)与更高的CAC类别相关。在单独的有序逻辑回归模型中,在对年龄、收缩压(SBP)、当前吸烟状况以及LDL胆固醇、HDL胆固醇和甘油三酯的传统指标进行调整后,小颗粒LDL、LDL颗粒以及大颗粒VLDL各自与更高的CAC呈正相关(p <0.05)。这些结果表明,脂蛋白亚类的测量或许能在传统血脂检测和CAD风险因素之外,进一步改善对绝经后女性CAD的预测。