Barter Philip, Gotto Antonio M, LaRosa John C, Maroni Jaman, Szarek Michael, Grundy Scott M, Kastelein John J P, Bittner Vera, Fruchart Jean-Charles
Heart Research Institute, Sydney, Australia.
N Engl J Med. 2007 Sep 27;357(13):1301-10. doi: 10.1056/NEJMoa064278.
High-density lipoprotein (HDL) cholesterol levels are a strong inverse predictor of cardiovascular events. However, it is not clear whether this association is maintained at very low levels of low-density lipoprotein (LDL) cholesterol.
A post hoc analysis of the recently completed Treating to New Targets (TNT) study assessed the predictive value of HDL cholesterol levels in 9770 patients. The primary outcome measure was the time to a first major cardiovascular event, defined as death from coronary heart disease, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. The predictive relationship between HDL cholesterol levels at the third month of treatment with statins and the time to the first major cardiovascular event was assessed in univariate and multivariate analyses and was also assessed for specific LDL cholesterol strata, including subjects with LDL cholesterol levels below 70 mg per deciliter (1.8 mmol per liter).
The HDL cholesterol level in patients receiving statins was predictive of major cardiovascular events across the TNT study cohort, both when HDL cholesterol was considered as a continuous variable and when subjects were stratified according to quintiles of HDL cholesterol level. When the analysis was stratified according to LDL cholesterol level in patients receiving statins, the relationship between HDL cholesterol level and major cardiovascular events was of borderline significance (P=0.05). Even among study subjects with LDL cholesterol levels below 70 mg per deciliter, those in the highest quintile of HDL cholesterol level were at less risk for major cardiovascular events than those in the lowest quintile (P=0.03).
In this post hoc analysis, HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins. This relationship was also observed among patients with LDL cholesterol levels below 70 mg per deciliter. (ClinicalTrials.gov number, NCT00327691 [ClinicalTrials.gov].).
高密度脂蛋白（HDL）胆固醇水平是心血管事件的有力反向预测指标。然而，尚不清楚在低密度脂蛋白（LDL）胆固醇水平极低时这种关联是否依然存在。
对近期完成的强化降脂治疗新目标（TNT）研究进行事后分析，评估了9770例患者中HDL胆固醇水平的预测价值。主要结局指标为首次发生重大心血管事件的时间，重大心血管事件定义为冠心病死亡、非致死性非手术相关心肌梗死、心脏骤停复苏、致死性或非致死性卒中。在单因素和多因素分析中评估了他汀类药物治疗第三个月时HDL胆固醇水平与首次发生重大心血管事件时间之间的预测关系，并针对特定的LDL胆固醇分层进行了评估，包括LDL胆固醇水平低于70毫克/分升（1.8毫摩尔/升）的受试者。
在整个TNT研究队列中，接受他汀类药物治疗患者的HDL胆固醇水平可预测重大心血管事件，无论是将HDL胆固醇视为连续变量，还是根据HDL胆固醇水平五分位数对受试者进行分层时均如此。当根据接受他汀类药物治疗患者的LDL胆固醇水平进行分层分析时，HDL胆固醇水平与重大心血管事件之间的关系具有临界显著性（P = 0.05）。即使在LDL胆固醇水平低于70毫克/分升的研究受试者中，HDL胆固醇水平最高五分位数的受试者发生重大心血管事件的风险也低于最低五分位数的受试者（P = 0.03）。
在这项事后分析中，HDL胆固醇水平可预测接受他汀类药物治疗患者的重大心血管事件。在LDL胆固醇水平低于70毫克/分升的患者中也观察到了这种关系。（临床试验注册号，NCT00327691 [ClinicalTrials.gov]。）
