Hadaegh Farzad, Harati Hadi, Ghanbarian Arash, Azizi Fereidoun
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Eur J Cardiovasc Prev Rehabil. 2006 Aug;13(4):571-7. doi: 10.1097/01.hjr.0000216552.81882.ca.
The aim of this study was to evaluate and compare the role of lipid markers including total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol with lipid indices (total/HDL cholesterol, LDL-cholesterol/HDL-cholesterol and non-HDL-cholesterol) as predictors of cardiovascular outcomes in adults over 30 years.
In a nested case-control study, 207 cardiovascular events among participants of the Tehran Lipid and Glucose Study (TLGS) were documented during 3 years of follow-up. Those cases that were free of cardiovascular disease at baseline (132 subjects) were matched to 264 controls for age and sex. In all subjects, demographic and clinical data including blood pressure and anthropometric measurements as well as serum lipids, fasting and 2-h plasma glucose were obtained from the database of the TLGS. We estimated the relative risk for each lipid parameter in a multiple stepwise regression model after adjustment for family history of premature coronary heart disease, smoking, systolic and diastolic blood pressure, fasting and 2-h plasma glucose and waist-to-hip ratio.
The relative risks associated with an increase of approximately 1 SD of independent lipid predictors in the multivariate model were as follows: total cholesterol, 1.6 (1.2-2.1), SD=1.3 mmol/l; LDL-cholesterol 1.5 (1.1-2.0), SD=1 mmol/l; non-HDL-cholesterol 1.6 (1.2-2.1), SD=1.2 mmol/l and cholesterol/HDL-cholesterol 1.5 (1.1-2.0), SD=1.8. Comparison of these four independent variables with receiver-operating characteristic curve analysis showed no significant difference in their predictive power for cardiovascular outcome. There was no association between HDL-cholesterol, triglyceride and LDL/HDL cholesterol and cardiovascular disease outcomes in multivariate analysis.
It seems that for short-term prediction of cardiovascular disease outcome, serum total cholesterol is the preferred lipid parameter to measure in the Iranian population.
本研究旨在评估和比较包括总胆固醇、低密度脂蛋白（LDL）胆固醇和高密度脂蛋白（HDL）胆固醇在内的血脂标志物与血脂指数（总胆固醇/HDL胆固醇、LDL胆固醇/HDL胆固醇和非HDL胆固醇）作为30岁以上成年人心血管疾病结局预测指标的作用。
在一项巢式病例对照研究中，德黑兰血脂与血糖研究（TLGS）的参与者在3年随访期间记录了207例心血管事件。那些基线时无心血管疾病的病例（132名受试者）按年龄和性别与264名对照进行匹配。在所有受试者中，从TLGS数据库获取人口统计学和临床数据，包括血压、人体测量指标以及血脂、空腹和2小时血浆葡萄糖。在对早发冠心病家族史、吸烟、收缩压和舒张压、空腹和2小时血浆葡萄糖以及腰臀比进行调整后，我们在多元逐步回归模型中估计了每个血脂参数的相对风险。
多变量模型中与独立血脂预测指标增加约1个标准差相关的相对风险如下：总胆固醇，1.6（1.2 - 2.1），标准差 = 1.3 mmol/l；LDL胆固醇1.5（1.1 - 2.0），标准差 = 1 mmol/l；非HDL胆固醇1.6（1.2 - 2.1），标准差 = 1.2 mmol/l；胆固醇/HDL胆固醇1.5（1.1 - 2.0），标准差 = 1.8。通过受试者工作特征曲线分析对这四个自变量进行比较，结果显示它们对心血管疾病结局的预测能力无显著差异。在多变量分析中，HDL胆固醇、甘油三酯和LDL/HDL胆固醇与心血管疾病结局之间无关联。
对于伊朗人群心血管疾病结局的短期预测，血清总胆固醇似乎是首选的血脂测量参数。
