Hansel Boris, Kontush Anatol, Giral Philippe, Bonnefont-Rousselot Dominique, Chapman M John, Bruckert Eric
Service d'Endocrinologie-Métabolisme (AP-HP), Hôpital de la Pitié, Paris, France.
Curr Med Res Opin. 2006 Jun;22(6):1149-60. doi: 10.1185/030079906X104821.
The objective of this study was to identify key determinants of high-density lipoprotein-cholesterol (HDL-C) level, including subclinical inflammation and insulin resistance, and to determine the prevalence of a low HDL-C phenotype in dyslipidaemic patients at high cardiovascular risk.
In a cross-sectional study, we assessed the prevalence of low HDL-C phenotypes in 14 667 dyslipidaemic patients attending our specialised lipid clinic and evaluated the potential relationships between HDL-C level and 16 clinical and biological parameters.
In univariate analysis, women exhibited higher plasma concentrations of HDL-C as compared with men. Levels of triglycerides, fasting blood glucose, uric acid, waist circumference, body mass index, high sensitivity C-reactive protein (hs-CRP), insulin resistance (as HOMA-IR index) and smoking were all negatively correlated with HDL-C, whereas age was positively correlated with HDL-C levels. Moderate drinkers (10-30 g/day) displayed higher HDL-C concentrations as compared with abstinent subjects; in contrast, consumption of more than 30 g alcohol/day was associated with a further non-significant elevation of HDL-C levels as compared to moderate drinkers. Multivariate analysis identified eight independent correlates of HDL-C. Age, sex and TG accounted for 37% of variability in HDL-C; modifiable factors including waist circumference, alcohol consumption and smoking, in addition to HOMA-IR and hs-CRP, accounted for an additional 5% of the variability in HDL-C. Using a cut-off of 40 mg/dL (1.03 mmol/L) for men and 50 mg/dL (1.29 mmol/L) for women, 33% and 28% of men and women displayed low levels of HDL-C.
Eight independent determinants of HDL-C account for 41% of variability in HDL-C in our dyslipidaemic population. Three of them, i.e. age, sex and degree of triglyceridaemia accounted for more than one third of such variability. The high prevalence of low HDL-C phenotypes in dyslipidaemic patients at elevated cardiovascular risk emphasises the need for both lifestyle and pharmacological strategies of intervention to raise HDL-C.
本研究旨在确定高密度脂蛋白胆固醇（HDL-C）水平的关键决定因素，包括亚临床炎症和胰岛素抵抗，并确定心血管风险高的血脂异常患者中低HDL-C表型的患病率。
在一项横断面研究中，我们评估了在我们专门的血脂门诊就诊的14667例血脂异常患者中低HDL-C表型的患病率，并评估了HDL-C水平与16项临床和生物学参数之间的潜在关系。
在单变量分析中，女性的HDL-C血浆浓度高于男性。甘油三酯、空腹血糖、尿酸、腰围、体重指数、高敏C反应蛋白（hs-CRP）、胰岛素抵抗（作为HOMA-IR指数）和吸烟水平均与HDL-C呈负相关，而年龄与HDL-C水平呈正相关。中度饮酒者（10-30克/天）的HDL-C浓度高于戒酒者；相比之下，与中度饮酒者相比，每天饮酒超过30克与HDL-C水平进一步非显著性升高有关。多变量分析确定了HDL-C的八个独立相关因素。年龄、性别和甘油三酯占HDL-C变异性的37%；可改变因素包括腰围、饮酒和吸烟，此外还有HOMA-IR和hs-CRP，占HDL-C变异性的另外5%。男性的临界值为40毫克/分升（1.03毫摩尔/升），女性为50毫克/分升（1.29毫摩尔/升），33%的男性和28%的女性HDL-C水平较低。
HDL-C的八个独立决定因素占我们血脂异常人群HDL-C变异性的41%。其中三个因素，即年龄、性别和甘油三酯血症程度占这种变异性的三分之一以上。心血管风险升高的血脂异常患者中低HDL-C表型的高患病率强调了通过生活方式和药物干预策略提高HDL-C的必要性。
