5641例接受冠状动脉造影的连续患者的高密度脂蛋白胆固醇、C反应蛋白与冠状动脉疾病的患病率及严重程度

High-density lipoprotein cholesterol, C-reactive protein, and prevalence and severity of coronary artery disease in 5641 consecutive patients undergoing coronary angiography.

作者信息

Alber H F, Wanitschek M M, de Waha S, Ladurner A, Suessenbacher A, Dörler J, Dichtl W, Frick M, Ulmer H, Pachinger O, Weidinger F

机构信息

Division of Cardiology, Innsbruck Medical University, Innsbruck, Austria.

出版信息

Eur J Clin Invest. 2008 Jun;38(6):372-80. doi: 10.1111/j.1365-2362.2008.01954.x.

DOI:10.1111/j.1365-2362.2008.01954.x

PMID:18489399

Abstract

BACKGROUND

Although high-density lipoprotein cholesterol (HDL-C) and C-reactive protein (CRP) are well-established predictors for future cardiovascular events, little information is available regarding their correlation with the prevalence and severity of angiographically evaluated coronary artery disease (CAD).

MATERIAL AND METHODS

Five thousand six hundred forty-one consecutive patients undergoing coronary angiography for the evaluation of CAD were analysed. Cardiovascular risk factors were assessed by routine blood chemistry and questionnaire. CAD severity was graded by visual estimation of lumen diameter stenosis with significant stenoses defined as lumen diameter reduction of >or= 70%. Coronary angiograms were graded as one-, two- or three-vessel disease, as nonsignificant CAD (lumen irregularities < 70%) or non-CAD.

RESULTS

HDL-C (60.3 +/- 18.5 vs. 51.9 +/- 15.3 mg dL(-1); P < 0.001) was higher and CRP was lower (0.65 +/- 1.68 vs. 1.02 +/- 2.38 mg dL(-1); P < 0.001) in non-CAD (n = 1517) compared to overall CAD patients (n = 4124). CAD patients were older (65.2 +/- 10.5 years vs. 59.9 +/- 11.4 years), more often diabetics (19.2% vs. 10.6%) and hypertensives (79.2% vs. 66.0%) and included more smokers (18.8% vs. 16.5%) (all P < 0.005). Low-density lipoprotein cholesterol (124.5 +/- 38.3 vs. 126.0 +/- 36.3 mg dL(-1); P = NS) was similar in overall CAD and non-CAD patients with more statin users (43.4% vs. 27.9%; P < 0.001) among CAD patients. Comparing non-CAD with different CAD severities using analysis of variance, results did not change substantially. In a multivariate analysis, HDL-C and CRP remained independently associated with the prevalence of CAD. In addition, HDL-C is also a potent predictor for the severity of CAD.

CONCLUSIONS

In this large consecutive patient cohort, HDL-C and CRP are independently associated with the prevalence of CAD. In this analysis, HDL-C is an even stronger predictor for CAD than some other major classical risk factors.

摘要

背景

尽管高密度脂蛋白胆固醇（HDL-C）和C反应蛋白（CRP）是未来心血管事件的公认预测指标，但关于它们与血管造影评估的冠状动脉疾病（CAD）的患病率和严重程度之间的相关性，目前所知甚少。

材料与方法

对5641例因评估CAD而连续接受冠状动脉造影的患者进行分析。通过常规血液化学检查和问卷调查评估心血管危险因素。CAD严重程度通过目测管腔直径狭窄程度进行分级，显著狭窄定义为管腔直径减少≥70%。冠状动脉造影分为单支、双支或三支血管病变、非显著性CAD（管腔不规则<70%）或非CAD。

结果

与总体CAD患者（n = 4124）相比，非CAD患者（n = 1517）的HDL-C更高（60.3±18.5 vs. 51.9±15.3 mg dL⁻¹；P < 0.001），CRP更低（0.65±1.68 vs. 1.02±2.38 mg dL⁻¹；P < 0.001）。CAD患者年龄更大（65.2±10.5岁 vs. 59.9±11.4岁），糖尿病患者更多（19.2% vs. 10.6%），高血压患者更多（79.2% vs. 66.0%），吸烟者也更多（18.8% vs. 16.5%）（所有P < 0.005）。总体CAD患者和非CAD患者的低密度脂蛋白胆固醇相似（124.5±38.3 vs. 126.0±36.3 mg dL⁻¹；P = 无显著性差异），CAD患者中使用他汀类药物的更多（43.4% vs. 27.9%；P < 0.001）。使用方差分析比较非CAD与不同严重程度的CAD，结果没有实质性变化。在多变量分析中，HDL-C和CRP仍然与CAD的患病率独立相关。此外，HDL-C也是CAD严重程度的有力预测指标。