Rahilly-Tierney Catherine, Bowman Thomas S, Djoussé Luc, Sesso Howard D, Gaziano J Michael
Massachusetts Veterans Epidemiology and Research Information Center, Office of Research and Development, Department of Veterans Affairs, Boston, Massachusetts, USA.
Am J Cardiol. 2008 Dec 15;102(12):1663-7. doi: 10.1016/j.amjcard.2008.07.055.
The association between change in high-density lipoprotein (HDL) cholesterol and risk of subsequent coronary heart disease (CHD) is unclear. Change in HDL cholesterol was calculated in a prospective cohort of 4,501 male physicians enrolled in the Physician's Health Study (PHS) I who had HDL cholesterol measured in 1982 and again approximately 14 years later. Subjects were divided into categories of those with a decrease (>or=-2.5 mg/dl), no change (change -2.5 to 2.5 mg/dl), a small increase of 2.5 to 12.5 mg/dl, or a large increase of >or=12.5 mg/dl. Cox proportional hazards was used to examine the association between change in HDL cholesterol and incident CHD (confirmed acute myocardial infarction or cardiac death). Hazard ratios (HRs) were adjusted for age, initial HDL cholesterol, diabetes mellitus, hypertension, non-HDL cholesterol, and history of cholesterol medication. Compared with subjects with a decrease in HDL cholesterol, multivariable-adjusted HRs for CHD were 0.66 (95% confidence interval [CI] 0.40 to 1.09) in subjects with no change, 0.56 (95% CI 0.35 to 0.89) for subjects with an increase of 2.5 to 12.5 mg/dl, and 0.43 (95% CI 0.23 to 0.83) for subjects with an HDL cholesterol increase >or=12.5 mg/dl. In conclusion, our findings were consistent with an inverse graded relation between 14-year increase in HDL cholesterol and risk of subsequent CHD.
高密度脂蛋白（HDL）胆固醇变化与后续冠心病（CHD）风险之间的关联尚不清楚。在参与医师健康研究（PHS）I的4501名男性医师前瞻性队列中计算HDL胆固醇变化，这些医师在1982年测量了HDL胆固醇，并在大约14年后再次测量。受试者被分为HDL胆固醇降低（≥-2.5mg/dl）、无变化（变化范围为-2.5至2.5mg/dl）、小幅升高（2.5至12.5mg/dl）或大幅升高（≥12.5mg/dl）几类。采用Cox比例风险模型来检验HDL胆固醇变化与新发CHD（确诊的急性心肌梗死或心源性死亡）之间的关联。风险比（HRs）针对年龄、初始HDL胆固醇、糖尿病、高血压、非HDL胆固醇以及胆固醇用药史进行了调整。与HDL胆固醇降低的受试者相比，HDL胆固醇无变化的受试者发生CHD的多变量调整后HR为0.66（95%置信区间[CI]0.40至1.09），升高2.5至12.5mg/dl的受试者为0.56（95%CI0.35至0.89），HDL胆固醇升高≥12.5mg/dl的受试者为0.43（95%CI0.23至0.83）。总之，我们的研究结果与HDL胆固醇14年升高与后续CHD风险之间的反向分级关系一致。
