Division of Cardiology, Department of Internal Medicine, University of Washington, Seattle, Washington 98104, USA.
J Am Coll Cardiol. 2010 Sep 21;56(13):1034-41. doi: 10.1016/j.jacc.2010.01.073.
The purpose of this study was to determine the association of combinations of lipid parameters with subclinical atherosclerosis.
Carotid intima-media thickness (CIMT) and coronary artery calcium (CAC) are significantly associated with incident cardiovascular disease (CVD). The association between common dyslipidemias (combined hyperlipidemia, [simple] hypercholesterolemia, dyslipidemia of metabolic syndrome, isolated low high-density lipoprotein cholesterol, and isolated hypertriglyceridemia) compared with normolipemia, and CIMT and CAC has not been previously examined.
The MESA (Multi-Ethnic Study of Atherosclerosis) participants were White, Chinese, African-American, or Hispanic adults without clinical CVD. Subjects with diabetes mellitus or who were receiving lipid-lowering therapy were excluded. Every participant was classified into only 1 of 6 groups defined by specific low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, or triglyceride cut points. Multivariate linear and relative risk regressions evaluated the cross-sectional associations with CIMT and CAC after adjusting for CVD risk factors. Interactions with race, sex, and high-sensitivity C-reactive protein were evaluated for CIMT and CAC outcomes.
Among 4,792 participants, only those with combined hyperlipidemia and hypercholesterolemia demonstrated both increased common CIMT (combined hyperlipidemia 0.048 mm thicker, 95% confidence interval [CI]: 0.016 to 0.080 mm; hypercholesterolemia 0.048 mm thicker, 95% CI: 0.029 to 0.067 mm) and internal CIMT (combined hyperlipidemia 0.120 mm thicker, 95% CI: 0.032 to 0.208 mm; and hypercholesterolemia 0.161 mm thicker, 95% CI: 0.098 to 0.223 mm) as well as increased risk for prevalent CAC (combined hyperlipidemia relative risk: 1.22, 95% CI: 1.08 to 1.38; hypercholesterolemia relative risk: 1.22, 95% CI: 1.11 to 1.34) compared with normolipemia. The interactions between lipid parameters and race, sex, or high-sensitivity C-reactive protein were not significant for any outcomes.
Combined hyperlipidemia and simple hypercholesterolemia were associated with increased CIMT and prevalent CAC in a relatively healthy multiethnic population.
本研究旨在确定血脂参数组合与亚临床动脉粥样硬化的关系。
颈动脉内膜中层厚度（CIMT）和冠状动脉钙（CAC）与心血管疾病（CVD）的发生显著相关。与正常血脂相比，常见血脂异常（混合性高脂血症、单纯高胆固醇血症、代谢综合征相关血脂异常、单纯低高密度脂蛋白胆固醇血症和单纯高甘油三酯血症）与 CIMT 和 CAC 的关系尚未被研究过。
MESA（动脉粥样硬化多民族研究）参与者为无临床 CVD 的白种人、中国人、非裔美国人或西班牙裔成年人。排除患有糖尿病或正在接受降脂治疗的患者。每位患者仅被归入通过特定低密度脂蛋白胆固醇、高密度脂蛋白胆固醇或甘油三酯切点定义的 6 组之一。在调整 CVD 危险因素后，多元线性和相对风险回归评估了与 CIMT 和 CAC 的横断面相关性。还评估了 CIMT 和 CAC 结果与种族、性别和高敏 C 反应蛋白之间的交互作用。
在 4792 名参与者中，只有合并高脂血症和高胆固醇血症的患者表现出 CIMT 普遍增厚（合并高脂血症增厚 0.048 毫米，95%置信区间[CI]：0.016 至 0.080 毫米；高胆固醇血症增厚 0.048 毫米，95%CI：0.029 至 0.067 毫米）和内 CIMT 增厚（合并高脂血症增厚 0.120 毫米，95%CI：0.032 至 0.208 毫米；高胆固醇血症增厚 0.161 毫米，95%CI：0.098 至 0.223 毫米），以及 CAC 发生率升高（合并高脂血症相对风险：1.22，95%CI：1.08 至 1.38；高胆固醇血症相对风险：1.22，95%CI：1.11 至 1.34）与正常血脂相比。血脂参数与种族、性别或高敏 C 反应蛋白之间的相互作用在任何结果中均不显著。
在一个相对健康的多民族人群中，混合性高脂血症和单纯性高胆固醇血症与 CIMT 增加和 CAC 发生率升高相关。
