From INSERM U 698, Paris, France; Paris Diderot - Sorbonne Paris City University, Paris, France; Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
From INSERM U 698, Paris, France; Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
Atherosclerosis. 2014 Jan;232(1):65-71. doi: 10.1016/j.atherosclerosis.2013.10.011. Epub 2013 Oct 26.
Common carotid artery (CCA) intima-media thickness (IMT), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), but not triglyceride levels, are markers of future cardiovascular events. The relationship between these three factors is, however, unclear.
We included six large observational studies that used the same harmonized, B-mode ultrasound protocol, the same software for IMT measurement by automatic edge detection on CCA in a plaque-free region, following the Mannheim consensus, and certification of all sonographers. Using the best view of the CCA, the sonographer had to confirm that the quality index was ≥ 0.5 on a measurement performed on 10-mm length. We used individual data meta-analysis to estimate the cross-sectional associations of lipids with CCA-IMT.
Overall, 21,587 patients with complete information on lipids and CCA-IMT were available. Age- and sex-adjusted CCA-IMT differed by -7.8 μm (95% CI -9.1 to -6.5 μm, P < 0.001) per 1 SD higher HDL-C level. After further adjustment for other atherosclerosis risk factors, the relationship was attenuated, but remained significant (regression coefficient, -3.7 μm; P < 0.001). This was found regardless of LDL-C levels (P for heterogeneity = 0.70). After adjustment for age and sex, triglycerides were positively associated with CCA-IMT, overall and in each LDL-C subgroup, but not after further adjustments for other risk factors.
Relationships between HDL-C and triglyceride levels and CCA-IMT were consistent with that previously observed with clinical events by the Emergency Risk Collaboration group, including at low LDL-C levels. This reinforces the need to verify whether raising HDL-C levels decreases both CCA-IMT and future clinical events.
颈总动脉（CCA）内膜-中层厚度（IMT）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C），但不是甘油三酯水平，是未来心血管事件的标志物。然而，这三个因素之间的关系尚不清楚。
我们纳入了六项使用相同的、协调一致的 B 型超声方案的大型观察性研究，使用自动边缘检测软件对无斑块区域的 CCA 进行 IMT 测量，遵循曼海姆共识，并对所有超声医师进行认证。超声医师必须使用 CCA 的最佳视图，确认在长度为 10mm 的测量中质量指数≥0.5。我们使用个体数据荟萃分析来估计血脂与 CCA-IMT 的横断面相关性。
总体而言，有 21587 名患者提供了完整的血脂和 CCA-IMT 信息。经年龄和性别调整后，每增加 1 个标准差的 HDL-C 水平，CCA-IMT 就会减少 7.8μm（95%CI：-9.1 至-6.5μm，P<0.001）。在进一步调整其他动脉粥样硬化危险因素后，这种关系虽然减弱，但仍然显著（回归系数为-3.7μm；P<0.001）。无论 LDL-C 水平如何（异质性 P 值=0.70），结果均如此。在调整年龄和性别后，甘油三酯与 CCA-IMT 呈正相关，总体上和每个 LDL-C 亚组均如此，但在进一步调整其他危险因素后则不然。
HDL-C 和甘油三酯水平与 CCA-IMT 的关系与紧急风险协作组先前观察到的与临床事件的关系一致，包括 LDL-C 水平较低时也是如此。这再次强调了需要验证升高 HDL-C 水平是否能降低 CCA-IMT 和未来的临床事件。
