Magnussen Costan G, Raitakari Olli T, Thomson Russell, Juonala Markus, Patel Dharmendrakumar A, Viikari Jorma S A, Marniemi Jukka, Srinivasan Sathanur R, Berenson Gerald S, Dwyer Terence, Venn Alison
Menzies Research Institute, University of Tasmania, Hobart, Tasmania 7001, Australia.
Circulation. 2008 Jan 1;117(1):32-42. doi: 10.1161/CIRCULATIONAHA.107.718981. Epub 2007 Dec 10.
New age- and sex-specific lipoprotein cut points developed from National Health and Nutrition Examination Survey (NHANES) data are considered to be a more accurate classification of a high-risk lipoprotein level in adolescents compared with existing cut points established by the National Cholesterol Education Program (NCEP). The aim of this study was to determine which of the NHANES or NCEP adolescent lipoprotein classifications was most effective for predicting abnormal levels in adulthood.
Adolescent and adult measures of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were collected in 365 Australian, 1185 Finnish, and 273 US subjects participating in 3 population-based prospective cohort studies. Lipoprotein variables in adolescence were classified according to NCEP and NHANES cut points and compared for their ability to predict abnormal levels in adulthood. With the use of diagnostic performance statistics (sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic curve) in pooled and cohort-stratified data, the NHANES cut points (compared with NCEP cut points) were more strongly predictive of low high-density lipoprotein cholesterol in adults but less predictive of high total cholesterol, high low-density lipoprotein cholesterol, and high triglyceride levels in adults. We identified heterogeneity in the relative usefulness of each classification between cohorts.
The separate use of NHANES cut points for high-density lipoprotein cholesterol and NCEP cut points for total cholesterol, low-density lipoprotein cholesterol, and triglycerides yielded the most accurate classification of adolescents who developed dyslipidemia in adulthood.
与美国国家胆固醇教育计划（NCEP）制定的现有切点相比，根据美国国家健康与营养检查调查（NHANES）数据制定的新的年龄和性别特异性脂蛋白切点被认为能更准确地对青少年的高危脂蛋白水平进行分类。本研究的目的是确定NHANES或NCEP青少年脂蛋白分类中哪一种对预测成年期异常水平最有效。
在参与3项基于人群的前瞻性队列研究的365名澳大利亚人、1185名芬兰人和273名美国人中收集了青少年和成年人的总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯测量值。青少年时期的脂蛋白变量根据NCEP和NHANES切点进行分类，并比较它们预测成年期异常水平的能力。在汇总数据和队列分层数据中使用诊断性能统计量（敏感性、特异性、阳性预测值、阴性预测值、受试者工作特征曲线下面积），NHANES切点（与NCEP切点相比）对成年人低密度脂蛋白胆固醇水平较低的预测更强，但对成年人高总胆固醇、高低密度脂蛋白胆固醇和高甘油三酯水平的预测较弱。我们发现各队列之间每种分类的相对有用性存在异质性。
单独使用NHANES高密度脂蛋白胆固醇切点以及NCEP总胆固醇、低密度脂蛋白胆固醇和甘油三酯切点，能最准确地对成年期出现血脂异常的青少年进行分类。
