Koro Carol E, Bowlin Steven J, Stump Timothy E, Sprecher Dennis L, Tierney William M
GlaxoSmithKline, Inc., Collegeville, PA, USA.
Am Heart J. 2006 Mar;151(3):755.e1-755.e6. doi: 10.1016/j.ahj.2005.12.007.
There is substantial evidence from clinical trials that lowering low-density lipoprotein cholesterol (LDL-C) reduces cardiovascular risk. There is less evidence for the salutatory effects of raising high-density lipoprotein cholesterol (HDL-C). The predictive strength of an initial HDL-C measurement and its change over time for major adverse coronary events is not well understood.
We identified a cohort of all 6928 patients in an urban primary care practice who had two or more lipid measurements between January 1985 and December 1997. We used bivariable and multivariable (Cox proportional hazards) techniques to identify independent predictors of subsequent major adverse coronary events (hospitalization for myocardial infarction or acute coronary syndrome) after the second set of lipid measurements.
The time between first and second lipid measurements averaged 2.6 years. During a mean of 5.1 +/- 3.2 years of observation after their second lipid measurements, 2167 (31%) patients had an acute coronary event. Patients having events were significantly older, more often white, male, and smokers and more often had antecedent diabetes, hypertension, coronary heart disease, and myocardial infarctions. Adjusting for covariates, a 10-mg/dL higher initial HDL-C was associated with an 11% (95% CI 7%-14%) lower risk of coronary events. A 10-mg/dL increase in HDL-C between lipid measurements was associated with a 7% (95% CI 3%-10%) lower risk of events. Neither initial or change in triglycerides nor LDL-C predicted subsequent coronary events.
High-density lipoprotein cholesterol measurements and change in HDL-C predicted major adverse coronary events in this urban practice, which provides support studying interventions targeting HDL-C for cardiovascular risk reduction.
临床试验有大量证据表明，降低低密度脂蛋白胆固醇（LDL-C）可降低心血管疾病风险。而关于升高高密度脂蛋白胆固醇（HDL-C）的有益效果的证据则较少。初次HDL-C测量及其随时间变化对主要不良冠状动脉事件的预测强度尚未得到充分了解。
我们确定了一组来自城市初级保健机构的6928名患者，他们在1985年1月至1997年12月期间进行了两次或更多次血脂测量。我们使用双变量和多变量（Cox比例风险）技术来确定第二次血脂测量后后续主要不良冠状动脉事件（因心肌梗死或急性冠状动脉综合征住院）的独立预测因素。
第一次和第二次血脂测量之间的时间平均为2.6年。在第二次血脂测量后的平均5.1±3.2年观察期内，2167名（31%）患者发生了急性冠状动脉事件。发生事件的患者年龄明显更大，更常见为白人、男性和吸烟者，并且更常患有前驱糖尿病、高血压、冠心病和心肌梗死。在对协变量进行调整后，初始HDL-C每升高10mg/dL，冠状动脉事件风险降低11%（95%CI 7%-14%）。两次血脂测量之间HDL-C升高10mg/dL与事件风险降低7%（95%CI 3%-10%）相关。甘油三酯的初始值或变化以及LDL-C均不能预测后续冠状动脉事件。
在该城市医疗机构中，高密度脂蛋白胆固醇测量值及HDL-C的变化可预测主要不良冠状动脉事件，这为研究针对HDL-C的心血管风险降低干预措施提供了支持。
