Framingham Heart Study, Center for Population Studies, National Heart, Lung, and Blood Institute, 73 Mt Wayte Avenue, Framingham, MA 01702, USA.
Circulation. 2009 Dec 8;120(23):2345-51. doi: 10.1161/CIRCULATIONAHA.109.830984. Epub 2009 Nov 23.
The relations of lipid concentrations to heart failure (HF) risk have not been elucidated comprehensively.
In 6860 Framingham Heart Study participants (mean age, 44 years; 54% women) free of baseline coronary heart disease, we related high-density lipoprotein cholesterol (HDL-C) and non-HDL-C to HF incidence during long-term follow-up, adjusting for clinical covariates and myocardial infarction at baseline and updating these at follow-up examinations. We evaluated dyslipidemia-specific population burden of HF by calculating population attributable risks. During follow-up (mean of 26 years), 680 participants (49% women) developed HF. Unadjusted HF incidence in the low (<160 mg/dL) versus high (> or =190 mg/dL) non-HDL-C groups was 7.9% and 13.8%, respectively, whereas incidence in the high (> or =55 [men], > or =65 [women] mg/dL) versus low (<40 [men], <50 [women] mg/dL) HDL-C groups was 6.1% and 12.8%, respectively. In multivariable models, baseline non-HDL-C and HDL-C, modeled as continuous measures, carried HF hazards (confidence intervals) of 1.19 (1.11 to 1.27) and 0.82 (0.75 to 0.90), respectively, per SD increment. In models updating lipid concentrations every 8 years, the corresponding hazards (confidence intervals) were 1.23 (1.16 to 1.31) and 0.77 (0.70 to 0.85). Participants with high baseline non-HDL-C and those with low HDL-C experienced a 29% and 40% higher HF risk, respectively, compared with those in the desirable categories; the population attributable risks for high non-HDL-C and low HDL-C were 7.5% and 15%, respectively. Hazards associated with non-HDL-C and HDL-C remained statistically significant after additional adjustment for interim myocardial infarction.
Dyslipidemia carries HF risk independent of its association with myocardial infarction, suggesting that lipid modification may be a means for reducing HF risk.
脂质浓度与心力衰竭（HF）风险的关系尚未得到全面阐明。
在 6860 名弗雷明汉心脏研究参与者（平均年龄 44 岁；54%为女性）中，我们在基线无冠心病的情况下，将高密度脂蛋白胆固醇（HDL-C）和非高密度脂蛋白胆固醇（non-HDL-C）与长期随访期间的 HF 发生率相关联，调整了临床协变量和基线心肌梗死，并在随访检查中更新了这些协变量。我们通过计算人群归因风险来评估特定于血脂异常的 HF 人群负担。在随访期间（平均 26 年），有 680 名参与者（49%为女性）发生 HF。未经调整的低（<160mg/dL）与高（≥190mg/dL）non-HDL-C 组 HF 发生率分别为 7.9%和 13.8%，而高（≥55[男性]，≥65[女性]mg/dL）与低（<40[男性]，<50[女性]mg/dL）HDL-C 组的 HF 发生率分别为 6.1%和 12.8%。在多变量模型中，基线 non-HDL-C 和 HDL-C 作为连续变量进行建模，每增加一个 SD，HF 危险度（置信区间）分别为 1.19（1.11 至 1.27）和 0.82（0.75 至 0.90）。在每 8 年更新血脂浓度的模型中，相应的危险度（置信区间）分别为 1.23（1.16 至 1.31）和 0.77（0.70 至 0.85）。与理想类别相比，基线 non-HDL-C 高和 HDL-C 低的参与者 HF 风险分别增加 29%和 40%；高 non-HDL-C 和低 HDL-C 的人群归因风险分别为 7.5%和 15%。在进一步调整中间心肌梗死后，non-HDL-C 和 HDL-C 与 HF 相关的危险度仍具有统计学意义。
血脂异常与 HF 风险相关，独立于其与心肌梗死的关系，这表明脂质修饰可能是降低 HF 风险的一种手段。
