空腹与非空腹低密度脂蛋白胆固醇水平对长期死亡率的预后价值：来自国家健康和营养调查 III（NHANES-III）的见解。

Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: insight from the National Health and Nutrition Examination Survey III (NHANES-III).

机构信息

From New York University School of Medicine, New York, NY (B.D., Y.G., J.X., H.W., S.B.); Brigham and Women's Hospital, Boston, MA (S.M.); and Stanford University School of Medicine, Department of Medicine, Stanford, CA (D.J.M.).

出版信息

Circulation. 2014 Aug 12;130(7):546-53. doi: 10.1161/CIRCULATIONAHA.114.010001. Epub 2014 Jul 11.

DOI:10.1161/CIRCULATIONAHA.114.010001

PMID:25015340

Abstract

BACKGROUND

National and international guidelines recommend fasting lipid panel measurement for risk stratification of patients for prevention of cardiovascular events. However, the prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol (LDL-C) is uncertain.

METHODS AND RESULTS

Patients enrolled in the National Health and Nutrition Examination Survey III (NHANES-III), a nationally representative cross-sectional survey performed from 1988 to 1994, were stratified on the basis of fasting status (≥8 or <8 hours) and followed for a mean of 14.0 (±0.22) years. Propensity score matching was used to assemble fasting and nonfasting cohorts with similar baseline characteristics. The risk of outcomes as a function of LDL-C and fasting status was assessed with the use of receiver operating characteristic curves and bootstrapping methods. The interaction between fasting status and LDL-C was assessed with Cox proportional hazards modeling. Primary outcome was all-cause mortality. Secondary outcome was cardiovascular mortality. One-to-one matching based on propensity score yielded 4299 pairs of fasting and nonfasting individuals. For the primary outcome, fasting LDL-C yielded prognostic value similar to that for nonfasting LDL-C (C statistic=0.59 [95% confidence interval, 0.57-0.61] versus 0.58 [95% confidence interval, 0.56-0.60]; P=0.73), and LDL-C by fasting status interaction term in the Cox proportional hazards model was not significant (Pinteraction=0.11). Similar results were seen for the secondary outcome (fasting versus nonfasting C statistic=0.62 [95% confidence interval, 0.60-0.66] versus 0.62 [95% confidence interval, 0.60-0.66]; P=0.96; Pinteraction=0.34).

CONCLUSIONS

Nonfasting LDL-C has prognostic value similar to that of fasting LDL-C. National and international agencies should consider reevaluating the recommendation that patients fast before obtaining a lipid panel.

摘要

背景

国家和国际指南建议对心血管事件预防的患者进行风险分层，检测空腹血脂谱。然而，空腹与非空腹低密度脂蛋白胆固醇（LDL-C）的预后价值尚不确定。

方法和结果

根据禁食状态（≥8 小时或<8 小时）对参加全国健康和营养检查调查 III（NHANES-III）的患者进行分层，该调查于 1988 年至 1994 年进行，是一项具有全国代表性的横断面调查，平均随访 14.0（±0.22）年。采用倾向评分匹配法将空腹和非空腹队列组装成具有相似基线特征的队列。使用接收者操作特征曲线和自举方法评估 LDL-C 和禁食状态与结果风险的关系。采用 Cox 比例风险模型评估禁食状态和 LDL-C 之间的相互作用。主要结局是全因死亡率。次要结局是心血管死亡率。基于倾向评分的一对一匹配产生了 4299 对空腹和非空腹个体。对于主要结局，空腹 LDL-C 的预后价值与非空腹 LDL-C 相似（C 统计量=0.59[95%置信区间，0.57-0.61]vs.0.58[95%置信区间，0.56-0.60]；P=0.73），Cox 比例风险模型中 LDL-C 与禁食状态的交互项无统计学意义（P 交互=0.11）。次要结局也有类似的结果（空腹与非空腹 C 统计量=0.62[95%置信区间，0.60-0.66]vs.0.62[95%置信区间，0.60-0.66]；P=0.96；P 交互=0.34）。