高密度脂蛋白胆固醇升高对冠心病总是有益吗？

Is elevated high-density lipoprotein cholesterol always good for coronary heart disease?

作者信息

Sun Yuhua, Yang Yuejin, Pei Weidong, Wu Yongjian, Zhao Jinglin

机构信息

Cardiovascular Institute and Fu Wai Heart Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Disease Control and Research, Beijing, China.

出版信息

Clin Cardiol. 2007 Nov;30(11):576-80. doi: 10.1002/clc.20137.

DOI:10.1002/clc.20137

PMID:18000966

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6653671/

Abstract

BACKGROUND

High-density lipoprotein (HDL) could enhance inflammation in atherogenesis when inflammatory response is present, and the activity of paraoxonase and antioxidant in HDL in the elderly is significantly decreased. There might be a different role for high-density lipoprotein cholesterol (HDL-C) between different age groups in patients with coronary heart disease (CHD).

METHODS

For this study, 225 inpatients with CHD (coronary atherosclerosis stenosis >/= 50% on >/= 1 major coronary arteries by coronary angiography), and 80 without CHD; 120 resting unstable angina patients, and 68 with stable angina were consecutively recruited. Risk factors were analyzed for CHD and resting unstable angina.

RESULTS

High-density lipoprotein cholesterol in resting unstable angina was higher than that in stable angina (1.24 +/- 1.05 versus 1.05 +/- 0.29 mmol/L, p = 0.032). After adjustment for age, sex, physical inactivity, hypertension, diabetes, C-reactive protein, triglycerides, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) the adjusted odds ratio (OR) (95% CI) of resting unstable angina was 10.19 (2.18-47.6, p = 0.003) for HDL-C. Risk factors were further investigated in different age groups. Adjusted OR of CHD associated with HDL-C in < 55-year-old group was 0.09 (0.01-0.66, p = 0.018), in >/= 55-year-old group it was 0.55 (0.08-3.82, p > 0.05). Adjusted OR of resting unstable angina associated with high HDL-C was 19.24 (2.86-129.4, p = 0.002) in patients aged >/= 55 years.

CONCLUSIONS

Elevated HDL-C might be an independent risk factor for resting unstable angina, even though HDL-C could play a much more important role in protection against coronary stenosis in younger or middle-aged persons.

摘要

背景

当存在炎症反应时，高密度脂蛋白（HDL）可在动脉粥样硬化形成过程中增强炎症，且老年人HDL中对氧磷酶活性和抗氧化能力显著降低。冠心病（CHD）患者不同年龄组之间，高密度脂蛋白胆固醇（HDL-C）可能发挥不同作用。

方法

本研究连续纳入225例冠心病住院患者（经冠状动脉造影显示≥1支主要冠状动脉的冠状动脉粥样硬化狭窄≥50%）以及80例非冠心病患者；120例静息性不稳定型心绞痛患者和68例稳定性心绞痛患者。分析冠心病和静息性不稳定型心绞痛的危险因素。

结果

静息性不稳定型心绞痛患者的高密度脂蛋白胆固醇高于稳定性心绞痛患者（1.24±1.05 vs 1.05±0.29 mmol/L，p = 0.032）。在调整年龄、性别、缺乏运动、高血压、糖尿病、C反应蛋白、甘油三酯、总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）后，HDL-C的静息性不稳定型心绞痛调整优势比（OR）（95%CI）为10.19（2.18 - 47.6，p = 0.003）。在不同年龄组中进一步研究危险因素。<55岁组中与HDL-C相关的冠心病调整OR为0.09（0.01 - 0.66，p = 0.018），≥55岁组中为0.55（0.08 - 3.82，p>0.05）。≥55岁患者中与高HDL-C相关的静息性不稳定型心绞痛调整OR为19.24（2.86 - 129.4，p = 0.002）。