Kaiser Permanente Center for Health Research, Portland, Oregon, USA.
Am J Cardiol. 2011 Oct 15;108(8):1124-8. doi: 10.1016/j.amjcard.2011.05.047.
The association between the changes in high-density lipoprotein (HDL) cholesterol and the risk of cardiovascular (CVD) or cerebrovascular hospitalization among patients with type 2 diabetes remains unclear. We conducted a retrospective observational cohort study of 30,067 members of the Kaiser Permanente Northwest and Georgia regions, who had type 2 diabetes and 2 HDL cholesterol measurements 6 to 24 months apart in 2001 to 2006. We followed up the cohort for ≤8 years (through 2009) to determine whether the change in HDL cholesterol was associated with subsequent CVD hospitalization. We examined the HDL cholesterol change continuously and by 3 categories: HDL cholesterol increased ≥6.5 mg/dl, decreased ≥6.5 mg/dl, or remained within ±6.4 mg/dl. The Cox regression models were adjusted for the baseline HDL cholesterol and demographic and clinical risk factors. During a mean follow-up of 55.8 ± 23.8 months, 3,023 patients (10.1%) experienced a CVD hospitalization. After multivariate adjustment, each 5 mg/dl of baseline HDL cholesterol was significantly associated with a 6% lower CVD hospitalization risk (hazard ratio 0.94 per 5 mg/dl, 95% confidence interval 0.92 to 0.95, p <0.0001) and each 5-mg/dl increase in HDL cholesterol was associated with a 4% CVD risk reduction (hazard ratio 0.96, 95% confidence interval 0.94 to 0.99, p <0.003). In the categorical analysis, a ≥6.5-mg/dl HDL cholesterol decrease was associated with an 11% increased CVD risk (hazard ratio 1.11, 95% confidence interval 1.00 to 1.24, p = 0.047) and a ≥6.5-mg/dl increase was associated with an 8% CVD risk reduction (hazard ratio 0.92, 95% confidence interval 0.84 to 1.01, p = 0.077) relative to those with stable HDL cholesterol. In conclusion, our results add to the growing body of evidence that increasing the HDL cholesterol levels might be an important strategy for CVD risk reduction. The prevention of HDL cholesterol decreases could be equally important.
高密度脂蛋白（HDL）胆固醇的变化与 2 型糖尿病患者心血管（CVD）或脑血管住院风险之间的关系尚不清楚。我们对 Kaiser Permanente Northwest 和 Georgia 地区的 30067 名成员进行了回顾性观察队列研究，这些成员在 2001 年至 2006 年期间有 2 次 HDL 胆固醇测量，间隔 6 至 24 个月。我们对队列进行了长达≤8 年（截至 2009 年）的随访，以确定 HDL 胆固醇的变化是否与随后的 CVD 住院有关。我们连续和按 3 个类别检查 HDL 胆固醇的变化：HDL 胆固醇增加≥6.5mg/dl、降低≥6.5mg/dl 或保持在±6.4mg/dl 内。Cox 回归模型根据基线 HDL 胆固醇和人口统计学及临床危险因素进行了调整。在平均 55.8±23.8 个月的随访期间，3023 名患者（10.1%）经历了 CVD 住院。经过多变量调整后，基线 HDL 胆固醇每增加 5mg/dl，CVD 住院风险降低 6%（风险比 0.94/5mg/dl，95%置信区间 0.92 至 0.95，p<0.0001），HDL 胆固醇每增加 5mg/dl，CVD 风险降低 4%（风险比 0.96，95%置信区间 0.94 至 0.99，p<0.003）。在分类分析中，HDL 胆固醇降低≥6.5mg/dl 与 CVD 风险增加 11%相关（风险比 1.11，95%置信区间 1.00 至 1.24，p=0.047），而 HDL 胆固醇增加≥6.5mg/dl 与 CVD 风险降低 8%相关（风险比 0.92，95%置信区间 0.84 至 1.01，p=0.077），与 HDL 胆固醇稳定的患者相比。总之，我们的研究结果进一步证明，增加 HDL 胆固醇水平可能是降低 CVD 风险的重要策略。预防 HDL 胆固醇的降低可能同样重要。
