Verdecchia Paolo, Reboldi Gianpaolo, Angeli Fabio, Gattobigio Roberto, Borgioni Claudia, Filippucci Lucia, Poeta Fabrizio, Porcellati Carlo
Ospedale R Silvestrini, Dipartimento Malattie Cardiovascolari, Italy.
Blood Press. 2004;13(5):295-303. doi: 10.1080/08037050410003991.
To evaluate distribution and prognostic value of total cholesterol and lipoprotein fractions in essential hypertension.
In a prospective cohort study, 2649 initially untreated subjects with essential hypertension (aged 51, 46.5% women) were investigated at entry and followed for a mean of 5.6 years (range: 1-16).
At entry, subjects with total cholesterol (TC) > or =240 mg/dl (> or =6.22 mmol/l) or high-density lipoprotein (HDL) cholesterol (HDL-C) <40 mg/dl (1.05 mmol/l) or low-density lipoprotein (LDL) cholesterol (LDL-C) > or =160 mg/dl (4.13 mmol/l) or TC/HDL-C ratio >6 were 47.7%. TC, HDL-C, LDL-C and triglycerides (TG) did not show any association with office or 24-h ambulatory blood pressure (BP). During follow-up there were 167 first cardiac events and 122 first cerebrovascular events. TC, HDL-C, LDL-C and TC/HDL-C ratio showed an association with cardiac events, but not with cerebrovascular events. TG did not show any association with cardiac or cerebrovascular events. After adjustment for age, sex, diabetes, smoking, left ventricular (LV) hypertrophy and 24-h pulse pressure, the hazard ratio for cardiac events was 1.83 (95% CI 1.23-2.71) in association with a TC > or =6.22 mmol/l, 2.23 with a HDL-C <1.05 mmol/l (95% CI 1.06-4.70), 2.83 with a LDL-C > or =4.91 mmol/l (95% CI 1.48-5.42) and 3.90 with a TC/HDL-C ratio >6.0 (95% CI 2.23-6.81). When forced in the same model, HDL-C and LDL-C showed an independent association with cardiac events.
Abnormalities of TC and lipoproteins are common in essential hypertension. HDL-C and LDL-C independently predict the risk of cardiac, but not cerebrovascular, events. Their predictive value is independent of several confounding factors including LV hypertrophy and ambulatory BP.
评估原发性高血压患者总胆固醇及脂蛋白各组分的分布情况及其预后价值。
在一项前瞻性队列研究中，对2649例初诊未接受治疗的原发性高血压患者（年龄51岁，女性占46.5%）进行了入组调查，并平均随访5.6年（范围：1 - 16年）。
入组时，总胆固醇（TC）≥240 mg/dl（≥6.22 mmol/l）或高密度脂蛋白（HDL）胆固醇（HDL-C）<40 mg/dl（1.05 mmol/l）或低密度脂蛋白（LDL）胆固醇（LDL-C）≥160 mg/dl（4.13 mmol/l）或TC/HDL-C比值>6的患者占47.7%。TC、HDL-C、LDL-C和甘油三酯（TG）与诊室血压或24小时动态血压（BP）均无关联。随访期间发生了167例首次心脏事件和122例首次脑血管事件。TC、HDL-C、LDL-C和TC/HDL-C比值与心脏事件相关，但与脑血管事件无关。TG与心脏或脑血管事件均无关联。在对年龄、性别、糖尿病、吸烟、左心室（LV）肥厚和24小时脉压进行校正后，与TC≥6.22 mmol/l相关的心脏事件风险比为1.83（95%可信区间1.23 - 2.71），与HDL-C<1.05 mmol/l相关的为2.23（95%可信区间1.06 - 4.70），与LDL-C≥4.91 mmol/l相关的为2.8
