Department of Internal Medicine, Wayne State University, Detroit, MI.
J Clin Lipidol. 2011 Mar-Apr;5(2):82-90. doi: 10.1016/j.jacl.2010.12.001. Epub 2010 Dec 17.
Comparative data on the prognostic utility of novel lipid parameters vs. conventional lipid parameters in predicting coronary events are scant.
We sought to compare the predictive value of various lipid measures for coronary events and to further examine the incremental value of novel lipid parameters over traditional cardiovascular risk factors in estimating cardiac risk.
We performed a post-hoc analysis of the National Heart Lung and Blood Institute limited access dataset of Multi-Ethnic Study of Atherosclerosis subjects (n = 6693). The lipid measures considered in the estimation of coronary risk were conventional and novel lipid parameters, the latter included total low-density lipoprotein (LDL), high-density lipoprotein (HDL) and very low-density lipoprotein (VLDL)-particle concentrations (LDL-p, HDL-p and VLDL-p), LDL-p/HDL-p ratio, and LDL-p subfractions. The outcome measured was occurrence of any coronary event (CE) that included myocardial infarction, resuscitated cardiac arrest, cardiac death, and angina.
During an average follow up of 4.5 years, 228 patients developed coronary events. In the multivariate Cox proportional hazards model, TC/HDL-c (HR: 3.27; 95% CI: 1.95 to 5.47, P < .0001) was a stronger predictor of CE. Among the novel lipid parameters, LDL-p/HDL-p (hazard ratio 2.84; 95% confidence interval 1.89 to 4.26; P < .0001) was a powerful independent predictor of CE. The c-statistics were similar for both LDL-p/HDL-p and TC/HDL-c ratios (0.60). The addition of LDL-p/HDL-p ratio to the Framingham risk score components resulted in a very small increase in the overall C statistic.
In our large study cohort, a predictive model for future coronary events incorporating the best-available novel lipid parameter (LDL-p/HDL-p ratio) was comparable with the same model that incorporated conventional lipid ratios such as the TC/HDL-c ratio . The use of LDL-p/HDL-p ratio did not appear to offer incremental value over more traditional risk prediction models.
关于新型血脂参数在预测冠脉事件方面优于传统血脂参数的预后价值的比较数据很少。
我们旨在比较各种血脂指标对冠脉事件的预测价值，并进一步探讨新型血脂参数在评估心脏风险方面相对于传统心血管危险因素的额外价值。
我们对国家心肺血液研究所多民族动脉粥样硬化研究（Multi-Ethnic Study of Atherosclerosis，MESA）的有限访问数据集进行了事后分析（n = 6693）。用于评估冠脉风险的血脂指标包括传统和新型血脂参数，后者包括总低密度脂蛋白（LDL）、高密度脂蛋白（HDL）和极低密度脂蛋白（VLDL）颗粒浓度（LDL-p、HDL-p 和 VLDL-p）、LDL-p/HDL-p 比值和 LDL-p 亚组分。测量的结果是任何冠脉事件（CE）的发生，包括心肌梗死、复苏性心脏骤停、心脏性死亡和心绞痛。
在平均 4.5 年的随访期间，228 例患者发生了冠脉事件。在多变量 Cox 比例风险模型中，TC/HDL-c（HR：3.27；95%CI：1.95 至 5.47，P <.0001）是 CE 的更强预测因子。在新型血脂参数中，LDL-p/HDL-p（危险比 2.84；95%置信区间 1.89 至 4.26；P <.0001）是 CE 的有力独立预测因子。LDL-p/HDL-p 比值和 TC/HDL-c 比值的 C 统计值相似（0.60）。将 LDL-p/HDL-p 比值添加到 Framingham 风险评分成分中，总体 C 统计值仅略有增加。
在我们的大型研究队列中，纳入最佳新型血脂参数（LDL-p/HDL-p 比值）的预测未来冠脉事件的模型与纳入传统血脂比值（如 TC/HDL-c 比值）的相同模型相当。使用 LDL-p/HDL-p 比值似乎并没有比更传统的风险预测模型提供额外的价值。
