Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada.
J Am Coll Cardiol. 2009 Dec 29;55(1):35-41. doi: 10.1016/j.jacc.2009.07.057.
This study was designed to test the hypothesis that at any low-density lipoprotein cholesterol (LDL-C) level, other lipid parameters such as non-high-density lipoprotein cholesterol (HDL-C) levels, triglyceride (TG) levels, and the total cholesterol (TC)/HDL-C are still associated with an increased coronary heart disease (CHD) risk.
Although LDL-C is considered to be the primary target of lipid-lowering therapy, other parameters of the lipoprotein-lipid profile may more closely associated with CHD risk.
In the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk prospective population study, 21,448 participants without diabetes or CHD between age 45 and 79 years were followed for 11.0 years. A total of 2,086 participants developed CHD during follow-up.
Among individuals with low LDL-C levels (<100 mg/dl), after adjustment for age, sex, smoking, systolic blood pressure, waist circumference, physical activity, and hormone replacement therapy (in women), those with non-HDL-C >130 mg/dl had a hazard ratio (HR) for future CHD of 1.84 (95% confidence interval [CI]: 1.12 to 3.04) when compared with those with non-HDL-C levels <130 mg/dl. In a similar model, individuals with TG levels >150 mg/dl had an HR of 1.63 (95% CI: 1.02 to 2.59) when compared with those with TG levels <150 mg/dl, and individuals with a TC/HDL-C ratio >5 had an HR of 2.19 (95% CI: 1.22 to 3.93) when compared with those with a TC/HDL-C ratio <5.
In this prospective study, independently of their plasma LDL-C levels, participants with high non-HDL-C levels, high TG levels, or with an elevated TC/HDL-C ratio were at increased CHD risk. CHD risk assessment algorithms as well as lipid targets of lipid-lowering trials may also need to consider other easily available parameters such as non-HDL-C.
本研究旨在验证一个假设，即在任何 LDL-C 水平下，其他脂质参数如非 HDL-C 水平、甘油三酯 (TG) 水平和 TC/HDL-C 比值与冠心病 (CHD) 风险增加仍相关。
虽然 LDL-C 被认为是降脂治疗的主要靶点，但脂蛋白脂质谱的其他参数可能与 CHD 风险更密切相关。
在 EPIC（欧洲前瞻性癌症与营养调查）-诺福克前瞻性人群研究中，21448 名年龄在 45 至 79 岁之间且无糖尿病或 CHD 的参与者随访 11.0 年。共有 2086 名参与者在随访期间发生 CHD。
在 LDL-C 水平较低（<100mg/dl）的个体中，在校正年龄、性别、吸烟、收缩压、腰围、体力活动和激素替代疗法（女性）后，非 HDL-C>130mg/dl 的个体发生未来 CHD 的风险比（HR）为 1.84（95%置信区间 [CI]：1.12 至 3.04），而非 HDL-C<130mg/dl 的个体。在类似的模型中，TG 水平>150mg/dl 的个体发生 CHD 的 HR 为 1.63（95%CI：1.02 至 2.59），TG 水平<150mg/dl 的个体，TC/HDL-C 比值>5 的个体发生 CHD 的 HR 为 2.19（95%CI：1.22 至 3.93），TC/HDL-C 比值<5 的个体。
在这项前瞻性研究中，无论其血浆 LDL-C 水平如何，非 HDL-C 水平较高、TG 水平较高或 TC/HDL-C 比值升高的参与者患 CHD 的风险增加。CHD 风险评估算法以及降脂试验的脂质目标可能还需要考虑其他易于获得的参数，如非 HDL-C。
