高密度脂蛋白胆固醇和颗粒浓度、颈动脉粥样硬化和冠状动脉事件：MESA（动脉粥样硬化的多民族研究）。
High-density lipoprotein cholesterol and particle concentrations, carotid atherosclerosis, and coronary events: MESA (multi-ethnic study of atherosclerosis).
机构信息
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania 15261, USA.
出版信息
J Am Coll Cardiol. 2012 Aug 7;60(6):508-16. doi: 10.1016/j.jacc.2012.03.060. Epub 2012 Jul 11.
OBJECTIVES
The purpose of this study was to evaluate independent associations of high-density lipoprotein cholesterol (HDL-C) and particle (HDL-P) concentrations with carotid intima-media thickness (cIMT) and incident coronary heart disease (CHD).
BACKGROUND
HDL-C is inversely related to CHD, and also to triglycerides, low-density lipoprotein particles (LDL-P), and related metabolic risk. HDL-P associations with CHD may be partially independent of these factors.
METHODS
In a multiethnic study of 5,598 men and women ages 45 to 84 years old, without baseline CHD, excluding subjects on lipid-lowering medications, triglycerides >400 mg/dl, or missing values, we evaluated associations of HDL-C and nuclear magnetic resonance spectroscopy-measured HDL-P with cIMT and incident CHD (myocardial infarction, CHD death, and angina, n = 227 events; mean 6.0 years follow-up). All models were adjusted for age, sex, ethnicity, hypertension, and smoking.
RESULTS
HDL-C and HDL-P correlated with each other (ρ = 0.69) and LDL-P (ρ = -0.38, -0.25, respectively, p < 0.05 for all). For (1 SD) higher HDL-C (15 mg/dl) or HDL-P (6.64 μmol/l), cIMT differences were - 26.1 (95% confidence interval [CI]: -34.7 to -17.4) μm and -30.1 (95% CI: -38.8 to - 21.4) μm, and CHD hazard ratios were 0.74 (95% CI: 0.63 to 0.88) and 0.70 (95% CI: 0.59 to 0.82), respectively. Adjusted for each other and LDL-P, HDL-C was no longer associated with cIMT (2.3; 95% CI: - 9.5 to 14.2 μm) or CHD (0.97; 95% CI: 0.77 to 1.22), but HDL-P remained independently associated with cIMT (-22.2; 95% CI: - 33.8 to -10.6 μm) and CHD (0.75; 95% CI: 0.61 to 0.93). Interactions by sex, ethnicity, diabetes, and high-sensitivity C-reactive protein were not significant.
CONCLUSIONS
Adjusting for each other and LDL-P substantially attenuated associations of HDL-C, but not HDL-P, with cIMT and CHD. Potential confounding by related lipids or lipoproteins should be carefully considered when evaluating HDL-related risk.
目的
本研究旨在评估高密度脂蛋白胆固醇（HDL-C）和颗粒（HDL-P）浓度与颈动脉内膜中层厚度（cIMT）和冠心病（CHD）发病的独立相关性。
背景
HDL-C 与 CHD 呈负相关，与甘油三酯、低密度脂蛋白颗粒（LDL-P）和相关代谢风险也呈负相关。HDL-P 与 CHD 的相关性可能部分独立于这些因素。
方法
在一项多民族研究中，纳入了年龄在 45 至 84 岁之间、无基线 CHD、未服用降脂药物、甘油三酯>400mg/dl 或存在缺失值的 5598 名男性和女性，我们评估了 HDL-C 和核磁共振光谱法测量的 HDL-P 与 cIMT 和冠心病（心肌梗死、CHD 死亡和心绞痛，n=227 例事件；平均 6.0 年随访）的相关性。所有模型均调整了年龄、性别、种族、高血压和吸烟。
结果
HDL-C 和 HDL-P 相互关联（ρ=0.69），与 LDL-P 也相关（ρ=-0.38，-0.25，p<0.05）。（1SD）更高的 HDL-C（15mg/dl）或 HDL-P（6.64μmol/L），cIMT 差异分别为-26.1（95%置信区间[CI]：-34.7 至-17.4）μm 和-30.1（95% CI：-38.8 至-21.4）μm，冠心病的危险比分别为 0.74（95% CI：0.63 至 0.88）和 0.70（95% CI：0.59 至 0.82）。调整相互之间和 LDL-P 后，HDL-C 与 cIMT（2.3；95% CI：-9.5 至 14.2μm）或冠心病（0.97；95% CI：0.77 至 1.22）不再相关，但 HDL-P 仍与 cIMT（-22.2；95% CI：-33.8 至-10.6μm）和冠心病（0.75；95% CI：0.61 至 0.93）独立相关。性别、种族、糖尿病和高敏 C 反应蛋白的交互作用无统计学意义。
结论
调整相互之间和 LDL-P 后，HDL-C 与 cIMT 和 CHD 的相关性显著减弱，但 HDL-P 仍与 cIMT 和 CHD 独立相关。在评估与 HDL 相关的风险时，应仔细考虑相关脂质或脂蛋白的潜在混杂因素。
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