Sarwar Nadeem, Danesh John, Eiriksdottir Gudny, Sigurdsson Gunnar, Wareham Nick, Bingham Sheila, Boekholdt S Matthijs, Khaw Kay-Tee, Gudnason Vilmundur
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, UK.
Circulation. 2007 Jan 30;115(4):450-8. doi: 10.1161/CIRCULATIONAHA.106.637793. Epub 2006 Dec 26.
Many epidemiological studies have reported on associations between serum triglyceride concentrations and the risk of coronary heart disease, but this association has not been reliably quantified. In the present study, we report 2 separate nested case-control comparisons in 2 different prospective, population-based cohorts, plus an updated meta-analysis of 27 additional prospective studies in general Western populations.
Measurements were made in a total of 3582 incident cases of fatal and nonfatal coronary heart disease and 6175 controls selected from among the 44,237 men and women screened in the Reykjavik and the European Prospective Investigation of Cancer (EPIC)-Norfolk studies. Repeat measurements were obtained an average of 4 years apart in 1933 participants in the EPIC-Norfolk Study and an average of 12 years apart in 379 participants in the Reykjavik study. The long-term stability of log-triglyceride values (within-person correlation coefficients of 0.64 [95% CI, 0.60 to 0.68] over 4 years and 0.63 [95% CI, 0.57 to 0.70] over 12 years) was similar to those of blood pressure and total serum cholesterol. After adjustment for baseline values of several established risk factors, the strength of the association was substantially attenuated, and the adjusted odds ratio for coronary heart disease was 1.76 (95% CI, 1.39 to 2.21) in the Reykjavik study and 1.57 (95% CI, 1.10 to 2.24) in the EPIC-Norfolk study in a comparison of individuals in the top third with those in the bottom third of usual log-triglyceride values. Similar overall findings (adjusted odds ratio, 1.72; 95% CI, 1.56 to 1.90) were observed in an updated meta-analysis involving a total of 10,158 incident coronary heart disease cases from 262,525 participants in 29 studies.
Available prospective studies in Western populations consistently indicate moderate and highly significant associations between triglyceride values and coronary heart disease risk. Because these associations depend considerably on levels of established risk factors, however, further studies are needed to help assess the nature of any independent associations.
许多流行病学研究报告了血清甘油三酯浓度与冠心病风险之间的关联，但这种关联尚未得到可靠的量化。在本研究中，我们报告了在两个不同的基于人群的前瞻性队列中进行的2项独立的巢式病例对照比较，以及对另外27项西方普通人群前瞻性研究的更新荟萃分析。
在雷克雅未克研究和欧洲癌症前瞻性调查（EPIC）-诺福克研究中筛选的44237名男性和女性中，共选取了3582例致命和非致命冠心病的发病病例及6175名对照进行测量。在EPIC-诺福克研究的1933名参与者中，平均每隔4年进行重复测量；在雷克雅未克研究的379名参与者中，平均每隔12年进行重复测量。甘油三酯对数数值的长期稳定性（4年内的个体内相关系数为0.64[95%CI，0.60至0.68]，12年内为0.63[CI，0.57至0.70]）与血压和总血清胆固醇相似。在对几种已确定的危险因素的基线值进行调整后，关联强度大幅减弱，在雷克雅未克研究中，冠心病的调整优势比为1.76（95%CI，1.39至2.21），在EPIC-诺福克研究中，在比较甘油三酯对数数值处于最高三分之一与最低三分之一的个体时，调整优势比为1.57（95%CI，1.10至2.24）。在一项更新的荟萃分析中观察到了类似的总体结果（调整优势比为1.72；95%CI，1.56至1.90），该分析涉及来自29项研究的262525名参与者中的10158例冠心病发病病例。
西方人群中现有的前瞻性研究一致表明甘油三酯值与冠心病风险之间存在中度且高度显著的关联。然而，由于这些关联在很大程度上取决于已确定的危险因素水平，因此需要进一步研究以帮助评估任何独立关联的性质。
