Di Angelantonio Emanuele, Sarwar Nadeem, Perry Philip, Kaptoge Stephen, Ray Kausik K, Thompson Alexander, Wood Angela M, Lewington Sarah, Sattar Naveed, Packard Chris J, Collins Rory, Thompson Simon G, Danesh John
JAMA. 2009 Nov 11;302(18):1993-2000. doi: 10.1001/jama.2009.1619.
Associations of major lipids and apolipoproteins with the risk of vascular disease have not been reliably quantified.
To assess major lipids and apolipoproteins in vascular risk.
DESIGN, SETTING, AND PARTICIPANTS: Individual records were supplied on 302,430 people without initial vascular disease from 68 long-term prospective studies, mostly in Europe and North America. During 2.79 million person-years of follow-up, there were 8857 nonfatal myocardial infarctions, 3928 coronary heart disease [CHD] deaths, 2534 ischemic strokes, 513 hemorrhagic strokes, and 2536 unclassified strokes.
Hazard ratios (HRs), adjusted for several conventional factors, were calculated for 1-SD higher values: 0.52 log(e) triglyceride, 15 mg/dL high-density lipoprotein cholesterol (HDL-C), 43 mg/dL non-HDL-C, 29 mg/dL apolipoprotein AI, 29 mg/dL apolipoprotein B, and 33 mg/dL directly measured low-density lipoprotein cholesterol (LDL-C). Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis.
The rates of CHD per 1000 person-years in the bottom and top thirds of baseline lipid distributions, respectively, were 2.6 and 6.2 with triglyceride, 6.4 and 2.4 with HDL-C, and 2.3 and 6.7 with non-HDL-C. Adjusted HRs for CHD were 0.99 (95% CI, 0.94-1.05) with triglyceride, 0.78 (95% CI, 0.74-0.82) with HDL-C, and 1.50 (95% CI, 1.39-1.61) with non-HDL-C. Hazard ratios were at least as strong in participants who did not fast as in those who did. The HR for CHD was 0.35 (95% CI, 0.30-0.42) with a combination of 80 mg/dL lower non-HDL-C and 15 mg/dL higher HDL-C. For the subset with apolipoproteins or directly measured LDL-C, HRs were 1.50 (95% CI, 1.38-1.62) with the ratio non-HDL-C/HDL-C, 1.49 (95% CI, 1.39-1.60) with the ratio apo B/apo AI, 1.42 (95% CI, 1.06-1.91) with non-HDL-C, and 1.38 (95% CI, 1.09-1.73) with directly measured LDL-C. Hazard ratios for ischemic stroke were 1.02 (95% CI, 0.94-1.11) with triglyceride, 0.93 (95% CI, 0.84-1.02) with HDL-C, and 1.12 (95% CI, 1.04-1.20) with non-HDL-C.
Lipid assessment in vascular disease can be simplified by measurement of either total and HDL cholesterol levels or apolipoproteins without the need to fast and without regard to triglyceride.
主要脂质和载脂蛋白与血管疾病风险之间的关联尚未得到可靠量化。
评估主要脂质和载脂蛋白在血管疾病风险中的作用。
设计、研究地点和参与者：来自68项长期前瞻性研究的302430名无初始血管疾病个体的记录，这些研究大多在欧洲和北美进行。在279万人年的随访期间，发生了8857例非致命性心肌梗死、3928例冠心病死亡、2534例缺血性中风、513例出血性中风和2536例未分类中风。
计算调整了几个传统因素后的风险比（HR），即1-SD更高值时的风险比：0.52对数(e)甘油三酯、15mg/dL高密度脂蛋白胆固醇（HDL-C）、43mg/dL非HDL-C、29mg/dL载脂蛋白AI、29mg/dL载脂蛋白B和33mg/dL直接测量的低密度脂蛋白胆固醇（LDL-C）。研究内回归分析针对个体内变异进行了调整，并使用荟萃分析进行合并。
在基线脂质分布的最低和最高三分位数中，每1000人年的冠心病发病率分别为：甘油三酯方面为2.6和6.2，HDL-C方面为6.4和2.4，非HDL-C方面为2.3和6.7。调整后的冠心病HR分别为：甘油三酯为0.99（95%CI，0.94-1.05），HDL-C为0.78（95%CI，0.74-0.82），非HDL-C为1.50（95%CI，1.39-1.61）。未禁食参与者的风险比至少与禁食参与者一样强。非HDL-C降低80mg/dL且HDL-C升高15mg/dL的组合下，冠心病的HR为0.35（95%CI，0.30-0.42）。对于有载脂蛋白或直接测量LDL-C的亚组，风险比分别为：非HDL-C/HDL-C比值为1.
