Department of Clinical Biochemistry, Heart of England NHS Foundation Trust, Sutton Coldfield, Birmingham, United Kingdom.
Metab Syndr Relat Disord. 2012 Jun;10(3):189-94. doi: 10.1089/met.2011.0112. Epub 2012 Jan 27.
Change in high-density lipoprotein cholesterol (HDL-C) observed in large randomized controlled trials using fibrates has varied. Inconsistent cardiovascular outcomes have also been the common theme of these trials. Subgroup analysis of even the negative trials, however, reveals significant reduction in cardiovascular disease in patients with low HDL-C and high triglycerides. We wished to study HDL-C change following fibrate therapy in our lipid clinic and determine the factors associated with HDL-C change.
Data were collected from case notes of patients started on fibrates (n=248) between 2002 and 2008 in the lipid clinics at Heart of England NHS Foundation Trust. Regression analyses were carried out to determine factors associated with changes in HDL-C.
Linear regression analysis revealed that HDL-C change was associated with pretreatment HDL-C (P<0.001), diabetes (P=0.004) and treatment duration (P=0.036). Multiple regression analysis with all of the factors in the model suggested that they were independent. Patients with a baseline HDL-C <1.0 mmol/L showed a greater HDL-C increase when compared to patients with a baseline HDL-C ≥1.0 mmol/L; HDL-C <1.0 mmol/L (increase of 0.15 mmol/L, linear regression: c=0.14, 95% confidence interval 0.05-0.30, P<0.001) and HDL-C ≥1.0 (increase of 0.002 mmol/L, linear regression: reference category). A similar relationship between change in HDL-C and baseline HDL-C was observed within groups stratified by patient characteristics (apart from those on concurrent statin therapy and females).
Our results may explain the discrepancies observed in some randomized controlled trials whereby subgroup analysis of patients with the metabolic syndrome appeared to show benefit whereas this was absent in the total cohort. Thus, future interventional studies using fibrates should perhaps focus on patients with low HDL-C levels.
使用贝特类药物进行的大型随机对照试验观察到高密度脂蛋白胆固醇（HDL-C）的变化各不相同。这些试验的共同主题也是不一致的心血管结局。然而，即使是阴性试验的亚组分析也揭示了低 HDL-C 和高甘油三酯患者心血管疾病的显著减少。我们希望在我们的脂质诊所研究贝特类药物治疗后 HDL-C 的变化，并确定与 HDL-C 变化相关的因素。
我们收集了 2002 年至 2008 年间在英格兰心脏 NHS 基金会信托基金的脂质诊所开始使用贝特类药物的患者（n=248）的病历数据。进行回归分析以确定与 HDL-C 变化相关的因素。
线性回归分析显示，HDL-C 的变化与治疗前的 HDL-C（P<0.001）、糖尿病（P=0.004）和治疗时间（P=0.036）有关。在模型中纳入所有因素的多元回归分析表明，它们是独立的。与基线 HDL-C≥1.0mmol/L 的患者相比，基线 HDL-C<1.0mmol/L 的患者 HDL-C 升高幅度更大；基线 HDL-C<1.0mmol/L（升高 0.15mmol/L，线性回归：c=0.14，95%置信区间 0.05-0.30，P<0.001）和基线 HDL-C≥1.0（升高 0.002mmol/L，线性回归：参考类别）。在按患者特征分层的组内，也观察到 HDL-C 变化与基线 HDL-C 之间的相似关系（除了同时接受他汀类药物治疗的患者和女性）。
我们的结果可能解释了一些随机对照试验中观察到的差异，其中代谢综合征患者的亚组分析似乎显示出获益，而在总队列中则没有。因此，未来使用贝特类药物的干预性研究可能应该关注 HDL-C 水平较低的患者。
