Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA.
Am J Cardiol. 2010 Feb 1;105(3):352-8. doi: 10.1016/j.amjcard.2009.09.040. Epub 2009 Dec 22.
Although abnormal lipoproteins and lipoprotein ratios are powerful risk factors for clinical cardiovascular events, these associations are stronger in younger than in older subjects. Whether age modifies the relation of lipoproteins and lipoprotein ratios to the relative risk of subclinical cardiovascular disease (CVD), as assessed by coronary artery calcium (CAC) scores, has not been examined in a contemporary, multiethnic cohort. We performed multivariate relative risk regression analyses to determine the relative risks for associations of lipoproteins and lipoprotein ratios with prevalent CAC in participants in Multi-Ethnic Study of Atherosclerosis (MESA). The participants were community-dwelling adults aged 45 to 84 years without clinically apparent CVD at baseline. We excluded those taking lipid-lowering therapy (15%) and stratified the results by decades of age. A total of 5,092 participants met the inclusion criteria. In the fully adjusted models, per SD of low-density lipoprotein, the age-stratified, adjusted relative risk for CAC was 1.17 (95% confidence interval [CI] 1.07 to 1.28) for those aged 45 to 84 years but was 1.05 (95% CI 1.01 to 1.10) for those aged 75 to 84 years (p-interaction = 0.12). The relative risk per SD of total/high-density lipoprotein cholesterol ratio was 1.20 (95% CI 1.12 to 1.29) for those aged 45 to 54 years but only 1.04 (95% CI 1.00 to 1.09) for those aged 75 to 84 years (p-interaction <0.001). The lipoproteins levels and lipoprotein ratios were associated with increased relative risks for CAC across all age categories. However, these associations were markedly attenuated by age. In conclusion, abnormal lipoprotein levels in middle age are a powerful risk factor for early atherosclerosis, as manifested by prevalent CAC.
虽然异常脂蛋白和脂蛋白比值是临床心血管事件的有力危险因素,但这些关联在年轻人群中比在老年人群中更强。在当代多民族队列中,尚未研究脂蛋白和脂蛋白比值与冠状动脉钙(CAC)评分评估的亚临床心血管疾病(CVD)的相对风险之间的关系是否会因年龄而改变。我们进行了多变量相对风险回归分析,以确定脂蛋白和脂蛋白比值与多民族动脉粥样硬化研究(MESA)参与者中 CAC 患病率的相关性的相对风险。参与者为年龄在 45 至 84 岁之间、基线时无明显临床 CVD 的社区居住成年人。我们排除了服用降脂治疗的参与者(15%),并按年龄十年进行了分层。共有 5092 名参与者符合纳入标准。在完全调整的模型中,对于年龄在 45 至 84 岁的人群,每标准差 LDL 水平,CAC 的年龄分层调整后相对风险为 1.17(95%CI 1.07 至 1.28),而对于年龄在 75 至 84 岁的人群为 1.05(95%CI 1.01 至 1.10)(p 交互=0.12)。对于年龄在 45 至 54 岁的人群,每标准差总/高密度脂蛋白胆固醇比值的相对风险为 1.20(95%CI 1.12 至 1.29),而对于年龄在 75 至 84 岁的人群,该比值仅为 1.04(95%CI 1.00 至 1.09)(p 交互<0.001)。在所有年龄组中,脂蛋白水平和脂蛋白比值与 CAC 的相对风险增加相关。然而,这些关联因年龄而明显减弱。总之,中年异常脂蛋白水平是早期动脉粥样硬化的有力危险因素,表现为 CAC 患病率增加。
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