Bittner Vera, Hardison Regina, Kelsey Sheryl F, Weiner Bonnie H, Jacobs Alice K, Sopko George
University of Alabama at Birmingham, Birmingham, AL 35294, USA.
Circulation. 2002 Nov 12;106(20):2537-42. doi: 10.1161/01.cir.0000038496.57570.06.
Current National Cholesterol Education Program guidelines recommend that non-high-density lipoprotein cholesterol (non-HDL-C) be considered a secondary target of therapy among individuals with triglycerides >2.26 mmol/L. It is not known whether non-HDL-C relates to prognosis among patients with coronary heart disease.
Lipid levels were available at baseline among 1514 patients (73% men; mean age, 61 years) enrolled in the Bypass Angioplasty Revascularization Investigation (BARI); all had multivessel coronary artery disease. Patients were followed for 5 years. Outcomes of death, nonfatal myocardial infarction, and death or myocardial infarction were modeled using univariate and multivariate time-dependent proportional hazards methods; angina pectoris at 5 years was modeled using univariate and multivariate logistic regression. Non-HDL-C was a strong and independent predictor of nonfatal myocardial infarction (multivariate relative risk, 1.049 [95% confidence intervals, 1.006 to 1.093] for every 0.26 mmol/L increase) and angina pectoris (multivariate odds ratio, 1.049 [95% confidence intervals, 1.004 to 1.096] for every 0.26 mmol/L increase), but it did not relate to mortality. HDL-C and LDL-C did not predict events during follow-up.
Among patients with lipid values in BARI, non-HDL-C is a strong and independent predictor of nonfatal myocardial infarction and angina pectoris at 5 years, even after consideration of powerful clinical variables. Our data suggest that non-HDL-C is an appropriate treatment target among patients with coronary heart disease.
当前的美国国家胆固醇教育计划指南建议，对于甘油三酯>2.26 mmol/L的个体，应将非高密度脂蛋白胆固醇（non-HDL-C）视为治疗的次要目标。目前尚不清楚non-HDL-C与冠心病患者的预后是否相关。
1514例患者（73%为男性；平均年龄61岁）参与了旁路血管成形术血运重建研究（BARI），所有患者均患有多支冠状动脉疾病，基线时均有血脂水平数据。对患者进行了5年的随访。采用单变量和多变量时间依赖性比例风险方法对死亡、非致命性心肌梗死以及死亡或心肌梗死的结局进行建模；采用单变量和多变量逻辑回归对5年时的心绞痛进行建模。Non-HDL-C是非致命性心肌梗死（每增加0.26 mmol/L，多变量相对风险为1.049 [95%置信区间，1.006至1.093]）和心绞痛（每增加0.26 mmol/L，多变量优势比为1.049 [95%置信区间，1.004至1.096]）的强有力且独立的预测因素，但与死亡率无关。HDL-C和LDL-C在随访期间未预测到事件发生。
在BARI研究中血脂水平的患者中，即使考虑了强大的临床变量，non-HDL-C仍是5年时非致命性心肌梗死和心绞痛的强有力且独立的预测因素。我们的数据表明，non-HDL-C是冠心病患者的一个合适的治疗目标。
