普通人群中非空腹甘油三酯与缺血性中风风险

Nonfasting triglycerides and risk of ischemic stroke in the general population.

作者信息

Freiberg Jacob J, Tybjaerg-Hansen Anne, Jensen Jan Skov, Nordestgaard Børge G

机构信息

Department of Clinical Biochemistry, Herlev Hospital, DK-2730 Herlev, Denmark.

出版信息

JAMA. 2008 Nov 12;300(18):2142-52. doi: 10.1001/jama.2008.621.

DOI:10.1001/jama.2008.621

PMID:19001625

Abstract

CONTEXT

The role of triglycerides in the risk of ischemic stroke remains controversial. Recently, a strong association was found between elevated levels of nonfasting triglycerides, which indicate the presence of remnant lipoproteins, and increased risk of ischemic heart disease.

OBJECTIVE

To test the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke in the general population.

DESIGN, SETTING, AND PARTICIPANTS: The Copenhagen City Heart Study, a prospective, Danish population-based cohort study initiated in 1976, with follow-up through July 2007. Participants were 13,956 men and women aged 20 through 93 years. A cross-sectional study included 9637 individuals attending the 1991-1994 examination of the prospective study.

MAIN OUTCOME MEASURES

Prospective study: baseline levels of nonfasting triglycerides, other risk factors at baseline and at follow-up examinations, and incidence of ischemic stroke. Cross-sectional study: levels of nonfasting triglycerides, levels of remnant cholesterol, and prevalence of ischemic stroke.

RESULTS

Of the 13,956 participants in the prospective study, 1529 developed ischemic stroke. Cumulative incidence of ischemic stroke increased with increasing levels of nonfasting triglycerides (log-rank trend, P < .001). Men with elevated nonfasting triglyceride levels of 89 through 176 mg/dL had multivariate-adjusted hazard ratios (HRs) for ischemic stroke of 1.3 (95% CI, 0.8-1.9; 351 events); for 177 through 265 mg/dL, 1.6 (95% CI, 1.0-2.5; 189 events); for 266 through 353 mg/dL, 1.5 (95% CI, 0.9-2.7; 73 events); for 354 through 442 mg/dL, 2.2 (95% CI, 1.1-4.2; 40 events); and for 443 mg/dL or greater, 2.5 (95% CI, 1.3-4.8; 41 events) vs men with nonfasting levels less than 89 mg/dL (HR, 1.0; 85 events) (P < .001 for trend). Corresponding values for women were 1.3 (95% CI, 0.9-1.7; 407 events), 2.0 (95% CI, 1.3-2.9; 135 events), 1.4 (95% CI, 0.7-2.9; 26 events), 2.5 (95% CI, 1.0-6.4; 13 events), and 3.8 (95% CI, 1.3-11; 10 events) vs women with nonfasting triglyceride levels less than 89 mg/dL (HR, 1.0; 159 events) (P < .001 for trend). Absolute 10-year risk of ischemic stroke ranged from 2.6% in men younger than 55 years with nonfasting triglyceride levels of less than 89 mg/dL to 16.7% in men aged 55 years or older with levels of 443 mg/dL or greater. Corresponding values in women were 1.9% and 12.2%. In the cross-sectional study, men with a previous ischemic stroke vs controls had nonfasting triglyceride levels of 191 (IQR, 131-259) mg/dL vs 148 (IQR, 104-214) mg/dL (P < .01); corresponding values for women were 167 (IQR, 121-229) mg/dL vs 127 (IQR, 91-181) mg/dL (P < .05). For remnant cholesterol, corresponding values were 38 (IQR, 26-51) mg/dL vs 29 (IQR, 20-42) mg/dL in men (P < .01) and 33 (IQR, 24-45) mg/dL vs 25 (IQR, 18-35) mg/dL in women (P < .05).

CONCLUSION

In this study population, nonfasting triglyceride levels were associated with risk of ischemic stroke.

摘要

背景

甘油三酯在缺血性中风风险中的作用仍存在争议。最近，发现非空腹甘油三酯水平升高（表明存在残留脂蛋白）与缺血性心脏病风险增加之间存在密切关联。

目的

检验非空腹甘油三酯水平升高与一般人群缺血性中风相关这一假设。

设计、地点和参与者：哥本哈根城市心脏研究，一项前瞻性、基于丹麦人群的队列研究，始于1976年，随访至2007年7月。参与者为13956名年龄在20至93岁之间的男性和女性。一项横断面研究纳入了参加1991 - 1994年前瞻性研究检查的9637人。

主要结局指标

前瞻性研究：非空腹甘油三酯的基线水平、基线及随访检查时的其他风险因素，以及缺血性中风的发病率。横断面研究：非空腹甘油三酯水平、残留胆固醇水平，以及缺血性中风的患病率。

结果

在前瞻性研究的13956名参与者中，1529人发生了缺血性中风。缺血性中风的累积发病率随非空腹甘油三酯水平升高而增加（对数秩检验趋势，P <.001）。非空腹甘油三酯水平升高至89至176 mg/dL的男性，缺血性中风的多变量调整风险比（HR）为1.3（95% CI，0.8 - 1.9；351例事件）；177至265 mg/dL者为1.6（95% CI，1.0 - 2.5；189例事件）；266至353 mg/dL者为1.5（95% CI，0.9 - 2.7；73例事件）；354至442 mg/dL者为2.2（95% CI，1.1 - 4.2；40例事件）；443 mg/dL及以上者为2.5（95% CI，1.3 - 4.8；41例事件）；而非空腹水平低于89 mg/dL的男性HR为1.0（85例事件）（趋势P <.001）。女性的相应值分别为1.3（95% CI，0.9 - 1.7；407例事件）、2.0（95% CI，1.3 - 2.9；135例事件）、1.4（95% CI，0.7 - 2.9；26例事件）、2.5（95% CI，1.0 - 6.4；13例事件）和3.8（95% CI，1.3 - 11；10例事件），而非空腹甘油三酯水平低于89 mg/dL的女性HR为1.0（159例事件）（趋势P <.001）。10年缺血性中风的绝对风险范围从非空腹甘油三酯水平低于89 mg/dL的55岁以下男性的2.6%到55岁及以上、水平为443 mg/dL及以上男性的16.7%。女性的相应值为1.9%和12.2%。在横断面研究中，有过缺血性中风的男性与对照组相比，非空腹甘油三酯水平为191（四分位间距，131 - 259）mg/dL，而对照组为148（四分位间距，104 - 214）mg/dL（P <.01）；女性的相应值分别为167（四分位间距，121 - 229）mg/dL和127（四分位间距，91 - 181）mg/dL（P <.0５）。对于残留胆固醇，男性的相应值分别为38（四分位间距，26 - 51）mg/dL和29（四分位间距，20 - 42）mg/dL（P <.01），女性为33（四分位间距，24 - 45）mg/dL和25（四分位间距，18 - 35）mg/dL（P <.05）。