强化与中等剂量阿托伐他汀治疗患者中氧化磷脂与载脂蛋白B-100的关系对心血管结局的影响：TNT试验
Relationship of oxidized phospholipids on apolipoprotein B-100 to cardiovascular outcomes in patients treated with intensive versus moderate atorvastatin therapy: the TNT trial.
作者信息
Byun Young Sup, Lee Jun-Hee, Arsenault Benoit J, Yang Xiaohong, Bao Weihang, DeMicco David, Laskey Rachel, Witztum Joseph L, Tsimikas Sotirios
机构信息
Division of Cardiovascular Diseases, University of California San Diego, La Jolla, California; Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
Division of Cardiovascular Diseases, University of California San Diego, La Jolla, California; Division of Cardiology, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Seoul, South Korea.
出版信息
J Am Coll Cardiol. 2015 Apr 7;65(13):1286-1295. doi: 10.1016/j.jacc.2015.01.050.
BACKGROUND
Oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB) is a biomarker of increased risk for major adverse cardiovascular events (MACE) in community cohorts, but its role in patients with stable coronary heart disease (CHD) is unknown.
OBJECTIVES
This study sought to examine the relationship between these oxidative biomarkers and cardiovascular outcomes in patients with established CHD.
METHODS
In a random sample from the TNT (Treating to New Targets) trial, OxPL-apoB levels were measured in 1,503 patients at randomization (after an 8-week run-in period taking atorvastatin 10 mg) and 1 year after being randomized to atorvastatin 10 or 80 mg. We examined the association between baseline levels of OxPL-apoB and MACE, defined as death from CHD, nonfatal myocardial infarction, resuscitation after cardiac arrest, and fatal/nonfatal stroke, as well as the effect of statin therapy on OxPL-apoB levels and MACE.
RESULTS
Patients with events (n = 156) had higher randomization levels of OxPL-apoB than those without events (p = 0.025). For the overall cohort, randomization levels of OxPL-apoB predicted subsequent MACE (hazard ratio [HR]: 1.21; 95% confidence interval: 1.04 to 1.41; p = 0.018) per doubling and tertile 3 versus tertile 1 (hazard ratio: 1.69; 95% confidence interval [CI]: 1.14 to 2.49; p = 0.01) after multivariate adjustment for age, sex, body mass index, among others, and treatment assignment. In the atorvastatin 10-mg group, tertile 3 was associated with a higher risk of MACE compared to the first tertile (HR: 2.08; 95% CI: 1.20 to 3.61; p = 0.01) but this was not significant in the atorvastatin 80-mg group (HR: 1.40; 95% CI: 0.80 to 2.46; p = 0.24).
CONCLUSIONS
Elevated OxPL-apoB levels predict secondary MACE in patients with stable CHD, a risk that is mitigated by atorvastatin 80 mg. (A Study to Determine the Degree of Additional Reduction in CV Risk in Lowering LDL Below Minimum Target Levels [TNT]; NCT00327691).
背景
载脂蛋白B - 100上的氧化磷脂（OxPL - apoB）是社区队列中主要不良心血管事件（MACE）风险增加的生物标志物，但其在稳定型冠心病（CHD）患者中的作用尚不清楚。
目的
本研究旨在探讨这些氧化生物标志物与已确诊冠心病患者心血管结局之间的关系。
方法
在TNT（强化降脂治疗新目标）试验的随机样本中，在1503例患者随机分组时（在服用10mg阿托伐他汀的8周导入期后）以及随机分组至10mg或80mg阿托伐他汀治疗1年后测量OxPL - apoB水平。我们研究了OxPL - apoB基线水平与MACE之间的关联，MACE定义为冠心病死亡、非致死性心肌梗死、心脏骤停复苏以及致死性/非致死性卒中，以及他汀类药物治疗对OxPL - apoB水平和MACE的影响。
结果
发生事件的患者（n = 156）的OxPL - apoB随机分组水平高于未发生事件的患者（p = 0.025）。对于整个队列，OxPL - apoB随机分组水平每增加一倍预测随后的MACE（风险比[HR]：1.21；95%置信区间：1.04至1.41；p = 0.018），在对年龄、性别、体重指数等进行多变量调整以及治疗分配后，第三分位数与第一分位数相比（风险比：1.69；95%置信区间[CI]：1.14至2.49；p = 0.01）。在阿托伐他汀10mg组中，与第一分位数相比，第三分位数与更高的MACE风险相关（HR：2.08；95%CI：1.20至3.61；p = 0.01），但在阿托伐他汀80mg组中这并不显著（HR：1.40；95%CI：0.80至2.46；p = 0.24）。
结论
升高的OxPL - apoB水平可预测稳定型冠心病患者的继发性MACE，80mg阿托伐他汀可降低这种风险。（一项确定将低密度脂蛋白降至最低目标水平以下时心血管风险进一步降低程度的研究[TNT]；NCT00327691）
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