Division of Clinical Cardiology, Department of CV Medicine, The Cleveland Clinic, Cleveland, OH, USA.
J Cardiovasc Pharmacol Ther. 2010 Dec;15(4):380-3. doi: 10.1177/1074248410374041. Epub 2010 Aug 5.
high-density lipoprotein (HDL) cholesterol is a well-established inverse risk factor for cardiovascular disease. The extent to which cardiovascular risk can be modified through changes in HDL, however, is less clear. We further examined the role of aggressive HDL raising therapy on cardiovascular outcomes in the 143 patients enrolled in the Armed Forces Regression Study (AFREGS).
reanalysis of the AFREGS population. Patients with stable coronary disease were randomized to receive gemfibrozil, niacin, and cholestyramine in combination or matching placebos, on top of aggressive dietary and exercise modification for a 30-month period. Blood work was performed at baseline and repeated after 1 year of therapy.
patients were divided into 3 groups based on their therapeutic response: no HDL increase, mild HDL increase, and large HDL increase (% change in HDL ≤ 0, ≤ the lower 2 tertiles of HDL increase, and > the upper tertile of HDL increase, respectively). A progressive decrease in cardiovascular events was noted across these groups (30.4%, 19.4%, and 3.2%, respectively, P = .01). Kaplan-Meier analysis according to percentage change in HDL demonstrated a similar improvement in event-free survival (P = .01). Proportional hazards modeling also demonstrated that increasing HDL predicted a lower hazard of cardiovascular events, even after adjusting for changes in low-density lipoprotein ([LDL] P < .01). For every 1% increase in HDL achieved, a 2% decrease in events was recognized.
these data suggest that in a population of patients with stable atherosclerosis, the greater the percentage increase in HDL achieved, the greater the cardioprotective benefit. This further supports HDL raising as a beneficial therapeutic strategy.
高密度脂蛋白（HDL）胆固醇是心血管疾病的一个明确的负向风险因素。然而，通过改变 HDL 可以在多大程度上改变心血管风险尚不清楚。我们进一步研究了在武装部队回归研究（AFREGS）中纳入的 143 例患者中，积极升高 HDL 的治疗对心血管结局的作用。
对 AFREGS 人群进行重新分析。稳定型冠心病患者被随机分为两组，一组接受吉非贝齐、烟酸和考来烯胺联合治疗，另一组接受安慰剂治疗，同时在 30 个月的时间内进行积极的饮食和运动改变。在基线和治疗 1 年后进行血液检查。
根据治疗反应，患者被分为 3 组：无 HDL 增加、轻度 HDL 增加和 HDL 大量增加（HDL 变化百分比分别为 0、HDL 增加的较低 2 个三分位数和 > HDL 增加的较高三分位数）。这些组中观察到心血管事件的发生率逐渐降低（分别为 30.4%、19.4%和 3.2%，P =.01）。根据 HDL 变化百分比的 Kaplan-Meier 分析显示，无事件生存率也有类似的改善（P =.01）。比例风险模型也表明，即使在调整了低密度脂蛋白（LDL）变化后，升高 HDL 也预示着心血管事件的风险降低（P <.01）。HDL 每增加 1%，事件减少 2%。
这些数据表明，在稳定动脉粥样硬化患者人群中，HDL 增加的百分比越高，心脏保护的益处越大。这进一步支持了升高 HDL 作为一种有益的治疗策略。
