载脂蛋白 B (ApoB) 与 LDL 胆固醇不匹配与未来的冠心病事件相关。
Discordance of low-density lipoprotein (LDL) cholesterol with alternative LDL-related measures and future coronary events.
机构信息
Divisions of Preventive (S.M., J.E.B., P.M.R.) and Cardiovascular Medicine (S.M., P.M.R.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
出版信息
Circulation. 2014 Feb 4;129(5):553-61. doi: 10.1161/CIRCULATIONAHA.113.005873. Epub 2013 Dec 17.
BACKGROUND
Low-density lipoprotein cholesterol (LDL-C) is the traditional measure of risk attributable to LDL. Non-high-density lipoprotein cholesterol (NHDL-C), apolipoprotein B (apoB), and LDL particle number (LDL-P) are alternative measures of LDL-related risk. However, the clinical utility of these measures may only become apparent among individuals for whom levels are inconsistent (discordant) with LDL-C.
METHODS AND RESULTS
LDL-C was measured directly, NHDL-C was calculated, apoB was measured with immunoassay, and LDL-P was measured with nuclear magnetic resonance spectroscopy among 27 533 healthy women (median follow-up 17.2 years; 1070 incident coronary events). Participants were grouped by median LDL-C (121 mg/dL) and each of NHDL-C, apoB, and LDL-P. Discordance was defined as LDL-C greater than or equal to the median and the alternative measure less than the median, or vice versa. Despite high LDL-C correlations with NHDL-C, apoB, and LDL-P (r=0.910, 0.785, and 0.692; all P<0.0001), prevalence of LDL-C discordance as defined by median cut points was 11.6%, 18.9%, and 24.3% for NHDL-C, apoB, and LDL-P, respectively. Among women with LDL-C less than the median, coronary risk was underestimated for women with discordant (greater than or equal to the median) NHDL-C (age-adjusted hazard ratio, 2.92; 95% confidence interval, 2.33-3.67), apoB (2.48, 2.01-3.07), or LDL-P (2.32, 1.88-2.85) compared with women with concordant levels. Conversely, among women with LDL-C greater than or equal to the median, risk was overestimated for women with discordant (less than the median) NHDL-C (0.40, 0.29-0.57), apoB (0.34, 0.26-0.46), or LDL-P (0.42, 0.33-0.53). After multivariable adjustment for potentially mediating factors, including HDL cholesterol and triglycerides, coronary risk remained underestimated or overestimated by ≈20% to 50% for women with discordant levels.
CONCLUSIONS
For women with discordant LDL-related measures, coronary risk may be underestimated or overestimated when LDL-C alone is used.
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT00000479.
背景
低密度脂蛋白胆固醇（LDL-C）是 LDL 所致风险的传统衡量指标。非高密度脂蛋白胆固醇（NHDL-C）、载脂蛋白 B（apoB）和 LDL 颗粒数（LDL-P）是 LDL 相关风险的替代衡量指标。然而，这些指标的临床实用性可能仅在 LDL-C 水平不一致（不一致）的个体中显现出来。
方法和结果
在 27533 名健康女性中（中位随访 17.2 年；1070 例冠心病事件），直接测量 LDL-C，计算 NHDL-C，用免疫测定法测量 apoB，用核磁共振光谱法测量 LDL-P。参与者按 LDL-C 中位数（121mg/dL）和 NHDL-C、apoB 和 LDL-P 中位数进行分组。不一致定义为 LDL-C 大于或等于中位数，而替代指标小于中位数，或反之亦然。尽管 LDL-C 与 NHDL-C、apoB 和 LDL-P 高度相关（r=0.910、0.785 和 0.692；所有 P<0.0001），但根据中位数切点定义的 LDL-C 不一致的患病率分别为 NHDL-C、apoB 和 LDL-P 的 11.6%、18.9%和 24.3%。在 LDL-C 低于中位数的女性中，与具有一致水平的女性相比，NHDL-C（年龄调整后的危险比，2.92；95%置信区间，2.33-3.67）、apoB（2.48，2.01-3.07）或 LDL-P（2.32，1.88-2.85）不一致的女性患冠心病的风险被低估。相反，在 LDL-C 大于或等于中位数的女性中，与具有一致水平的女性相比，NHDL-C（0.40，0.29-0.57）、apoB（0.34，0.26-0.46）或 LDL-P（0.42，0.33-0.53）不一致的女性的风险被高估。在对可能的中介因素（包括高密度脂蛋白胆固醇和甘油三酯）进行多变量调整后，对于具有不一致水平的女性，冠心病风险仍被低估或高估了约 20%至 50%。
结论
对于具有不一致的 LDL 相关指标的女性，当仅使用 LDL-C 时，冠心病风险可能被低估或高估。
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