甘油三酯/高密度脂蛋白胆固醇比值可预测疑似心肌缺血女性的全因死亡率：来自女性缺血综合征评估（WISE）的报告。
The triglyceride/high-density lipoprotein cholesterol ratio predicts all-cause mortality in women with suspected myocardial ischemia: a report from the Women's Ischemia Syndrome Evaluation (WISE).
作者信息
Bittner Vera, Johnson B Delia, Zineh Issam, Rogers William J, Vido Diane, Marroquin Oscar C, Bairey-Merz C Noel, Sopko George
机构信息
Department of Medicine, University of Alabama at Birmingham, USA.
出版信息
Am Heart J. 2009 Mar;157(3):548-55. doi: 10.1016/j.ahj.2008.11.014.
UNLABELLED
High triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) are important cardiovascular risk factors in women. The prognostic utility of the TG/HDL-C ratio, a marker for insulin resistance and small dense low-density lipoprotein particles, is unknown among high-risk women.
METHODS
We studied 544 women without prior myocardial infarction or coronary revascularization, referred for clinically indicated coronary angiography and enrolled in the Women's Ischemia Syndrome Evaluation (WISE). Fasting lipid profiles and detailed demographic and clinical data were obtained at baseline. Multivariate Cox-proportional hazards models for all-cause mortality and cardiovascular events (death, myocardial infarction, heart failure, stroke) over a median follow-up of 6 years were constructed using log TG/HDL-C ratio as a predictor variable and accounting for traditional cardiovascular risk factors.
RESULTS
Mean age was 57 +/- 11 years; 84% were white, 55% hypertensive, 20% diabetic, 50% current or prior smokers. Triglyceride/HDL-C ranged from 0.3 to 18.4 (median 2.2, first quartile 0.35 to <1.4, fourth quartile 3.66-18.4). Deaths (n = 33) and cardiovascular events (n = 83) increased across TG/HDL-C quartiles (both P < .05 for trend). Triglyceride/HDL-C was a strong independent predictor of mortality in models adjusted for age, race, smoking, hypertension, diabetes, and angiographic coronary disease severity (hazard ratio 1.95, 95% CI 1.05-3.64, P = .04). For cardiovascular events, the multivariate hazard ratio was 1.54 (95% CI 1.05-2.22, P = .03) when adjusted for demographic and clinical variables, but became nonsignificant when angiographic results were included.
CONCLUSION
Among women with suspected ischemia, the TG/HDL-C ratio is a powerful independent predictor of all-cause mortality and cardiovascular events.
未标注
高甘油三酯（TG）和低高密度脂蛋白胆固醇（HDL-C）是女性重要的心血管危险因素。甘油三酯/高密度脂蛋白胆固醇比值作为胰岛素抵抗和小而密低密度脂蛋白颗粒的标志物，其在高危女性中的预后价值尚不清楚。
方法
我们研究了544名既往无心肌梗死或冠状动脉血运重建的女性，她们因临床需要接受冠状动脉造影，并纳入了女性缺血综合征评估（WISE）研究。在基线时获取空腹血脂谱以及详细的人口统计学和临床数据。使用对数甘油三酯/高密度脂蛋白胆固醇比值作为预测变量，并考虑传统心血管危险因素，构建了中位随访6年期间全因死亡率和心血管事件（死亡、心肌梗死、心力衰竭、中风）的多变量Cox比例风险模型。
结果
平均年龄为57±11岁；84%为白人，55%患有高血压，20%患有糖尿病，50%为当前吸烟者或既往吸烟者。甘油三酯/高密度脂蛋白胆固醇比值范围为0.3至18.4（中位数2.2，第一四分位数0.35至<1.4，第四四分位数3.66 - 18.4）。全因死亡（n = 33）和心血管事件（n = 83）在甘油三酯/高密度脂蛋白胆固醇四分位数间呈增加趋势（趋势P值均<0.05）。在调整年龄、种族、吸烟、高血压、糖尿病和血管造影显示的冠状动脉疾病严重程度的模型中，甘油三酯/高密度脂蛋白胆固醇是死亡率的强独立预测因子（风险比1.95，95%可信区间1.05 - 3.64，P = 0.04）。对于心血管事件，在调整人口统计学和临床变量后，多变量风险比为1.54（95%可信区间1.05 - 2.22，P = 0.03），但纳入血管造影结果后则无统计学意义。
结论
在疑似缺血的女性中，甘油三酯/高密度脂蛋白胆固醇比值是全因死亡率和心血管事件的有力独立预测因子。
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