Tsukinoki Rumi, Okamura Tomonori, Watanabe Makoto, Kokubo Yoshihiro, Higashiyama Aya, Nishimura Kunihiro, Takegami Misa, Murakami Yoshitaka, Okayama Akira, Miyamoto Yoshihiro
Department of Public Health Nursing, Osaka Medical College, Takatsuki, Osaka, Japan;
Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan;
Am J Hypertens. 2014 Nov;27(11):1362-9. doi: 10.1093/ajh/hpu059. Epub 2014 Apr 8.
Blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) are risk factors for coronary artery disease (CAD) and ischemic stroke. However, the hazards of their coexistence are not fully understood in Asian populations. We investigated whether the relationship between BP and cardiovascular disease (CVD) outcomes are modified by LDL-C level in a Japanese population.
Individuals aged 30-79 years (n = 5,151) were classified into 6 groups according to LDL-C levels (<140 and ≥140mg/dL or lipid medication) and BP levels (optimal BP, prehypertension, and hypertension; reference: low LDL-C and optimal BP). Hazard ratios (HRs) were calculated after adjusting for age, high-density lipoprotein cholesterol, diabetes, smoking status, and alcohol consumption. The effect modification of LDL-C on BP-CVD association was assessed using likelihood ratio tests.
There were 264 CAD and 215 ischemic stroke events during 13 years of follow-up. With low LDL-C, the HRs of prehypertension and hypertension for CAD were 2.01 and 4.71, respectively. Similar trends of HRs were observed with high LDL-C (optimal BP = 2.09, prehypertension = 3.45, hypertension = 5.94). However, the HRs for ischemic stroke did not differ between normal and high LDL-C levels at the same BP level. The apparent effect modification of LDL-C was not observed in the BP-CVD association in either CAD (P = 0.48) or ischemic stroke (P = 0.39).
The HRs for CAD in prehypertensive and hypertensive groups were higher than those in the optimal BP group at the same LDL-C levels in a Japanese population; however, there was no statistical effect modification of LDL-C on the BP-CAD association.
血压（BP）和低密度脂蛋白胆固醇（LDL-C）是冠状动脉疾病（CAD）和缺血性卒中的危险因素。然而，在亚洲人群中，它们共存的危害尚未完全明确。我们调查了在日本人群中，LDL-C水平是否会改变BP与心血管疾病（CVD）结局之间的关系。
将年龄在30 - 79岁的个体（n = 5151）根据LDL-C水平（<140和≥140mg/dL或使用降脂药物）和BP水平（理想BP、高血压前期和高血压；参照：低LDL-C和理想BP）分为6组。在调整年龄、高密度脂蛋白胆固醇、糖尿病、吸烟状况和饮酒量后计算风险比（HRs）。使用似然比检验评估LDL-C对BP-CVD关联的效应修正。
在13年的随访期间，有264例CAD事件和215例缺血性卒中事件。LDL-C水平较低时，高血压前期和高血压患者发生CAD的HR分别为2.01和4.71。LDL-C水平较高时观察到类似的HR趋势（理想BP = 2.09，高血压前期 = 3.45，高血压 = 5.94）。然而，在相同BP水平下，正常和高LDL-C水平的缺血性卒中HR没有差异。在CAD（P = 0.48）或缺血性卒中（P = 0.39）的BP-CVD关联中均未观察到LDL-C明显的效应修正。
在日本人群中，相同LDL-C水平下，高血压前期和高血压组发生CAD的HR高于理想BP组；然而，LDL-C对BP-CAD关联没有统计学上有效的修正作用。
