Barzi F, Patel A, Woodward M, Lawes C M M, Ohkubo T, Gu D, Lam T H, Ueshima H
The George Institute for International Health, University of Sydney, Camperdown, NSW 2050, Australia.
Ann Epidemiol. 2005 May;15(5):405-13. doi: 10.1016/j.annepidem.2005.01.005.
Many guidelines advocate measurement of total or low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides (TG) to determine treatment recommendations for preventing coronary heart disease (CHD) and cardiovascular disease (CVD). This analysis is a comparison of lipid variables as predictors of cardiovascular disease.
Hazard ratios for coronary and cardiovascular deaths by fourths of total cholesterol (TC), LDL, HDL, TG, non-HDL, TC/HDL, and TG/HDL values, and for a one standard deviation change in these variables, were derived in an individual participant data meta-analysis of 32 cohort studies conducted in the Asia-Pacific region. The predictive value of each lipid variable was assessed using the likelihood ratio statistic.
Adjusting for confounders and regression dilution, each lipid variable had a positive (negative for HDL) log-linear association with fatal CHD and CVD. Individuals in the highest fourth of each lipid variable had approximately twice the risk of CHD compared with those with lowest levels. TG and HDL were each better predictors of CHD and CVD risk compared with TC alone, with test statistics similar to TC/HDL and TG/HDL ratios. Calculated LDL was a relatively poor predictor.
While LDL reduction remains the main target of intervention for lipid-lowering, these data support the potential use of TG or lipid ratios for CHD risk prediction.
许多指南提倡测量总胆固醇或低密度脂蛋白胆固醇（LDL）、高密度脂蛋白胆固醇（HDL）和甘油三酯（TG），以确定预防冠心病（CHD）和心血管疾病（CVD）的治疗建议。本分析旨在比较脂质变量作为心血管疾病预测指标的情况。
在一项对亚太地区开展的32项队列研究的个体参与者数据荟萃分析中，得出了按总胆固醇（TC）、LDL、HDL、TG、非HDL、TC/HDL和TG/HDL值的四分位数划分的冠心病和心血管疾病死亡风险比，以及这些变量每变化一个标准差的风险比。使用似然比统计量评估每个脂质变量的预测价值。
在对混杂因素和回归稀释进行调整后，每个脂质变量与致命性冠心病和心血管疾病均呈正（HDL为负）对数线性关联。每个脂质变量处于最高四分位数的个体患冠心病的风险约为处于最低水平个体的两倍。与单独的TC相比，TG和HDL各自都是冠心病和心血管疾病风险的更好预测指标，检验统计量与TC/HDL和TG/HDL比值相似。计算得出的LDL是一个相对较差的预测指标。
虽然降低LDL仍然是降脂干预的主要目标，但这些数据支持将TG或脂质比值用于冠心病风险预测的可能性。
