Mark Laszlo, Vallejo-Vaz Antonio J, Reiber Istvan, Paragh György, Kondapally Seshasai Sreenivasa Rao, Ray Kausik K
2nd Department of Medicine - Cardiology, Pandy Kalman Bekes County Hospital, Gyula, Hungary.
Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK.
Atherosclerosis. 2015 Jul;241(1):62-8. doi: 10.1016/j.atherosclerosis.2015.04.810. Epub 2015 Apr 30.
Non-HDL cholesterol represents the pro-atherogenic, apo-B-containing lipoprotein fraction of circulating lipids, and represents a secondary target for CVD prevention in people with diabetes. We therefore assessed the proportion of individuals with diabetes and CVD who attain a non-HDL-C goal of <2.6 mmol/L, the extent to which triglycerides influence this goal attainment, and their relationship with HDL-C and triglyceride-rich lipoproteins (TRL).
Of 2674 diabetic subjects with baseline CVD in the Hungarian MULTI-GAP programme (mean age 64.8 years, mean HbA1c 7.2%), an LDL-C goal <1.8 and non-HDL-C goal <2.6 mmol/L was attained in 13.5% and 17.7% individuals, respectively. Non-HDL-C goal attainment declined at higher triglyceride concentrations; and graphically this relationship appeared to be continuously and inversely associated with triglyceride concentrations. In contrast, the relationship between LDL-C goal attainment was inversely and continuously associated with triglyceride levels up to about 2.5 mmol/L, after which the graphical appearance plateaued such that no further difference in LDL-C were observed beyond triglyceride levels of 2.5 mmol/L. With increasing triglyceride concentrations, non-HDL-C increased continuously, HDL-C decreased initially but later plateaued (at 1.5-2.0 [men] or 2.0-2.5 mmol/L [women]), LDL-C levels plateaued at about 2.0-2.5 mmol/L, and TRL-cholesterol (non-HDL-C minus LDL-C) rose continuously. In multivariable-adjusted models, elevated triglyceride concentrations, non-specialist care and uncontrolled blood pressure were inversely associated with non-HDL-C goal attainment. Triglyceride levels were more strongly associated with non-HDL-C than with LDL-C goal attainment (ORs per 1-SD increase in log-triglycerides was 0.74, 95% CI 0.61-0.89, for LDL-C goal attainment, and 0.49, 95% CI 0.38-0.61, for non-HDL-C goal attainment).
Non-HDL-C goal attainment was suboptimal in people with diabetes and co-existing CVD. This was most marked at higher triglyceride levels, possibly due to higher levels of TRL.
非高密度脂蛋白胆固醇代表循环脂质中具有致动脉粥样硬化性、含载脂蛋白B的脂蛋白部分，是糖尿病患者心血管疾病预防的次要靶点。因此，我们评估了糖尿病合并心血管疾病患者中达到非高密度脂蛋白胆固醇目标值<2.6 mmol/L的个体比例、甘油三酯对实现该目标的影响程度，以及它们与高密度脂蛋白胆固醇和富含甘油三酯的脂蛋白（TRL）的关系。
在匈牙利的MULTI - GAP项目中，2674名患有基线心血管疾病的糖尿病受试者（平均年龄64.8岁，平均糖化血红蛋白7.2%）中，分别有13.5%和17.7%的个体实现了低密度脂蛋白胆固醇目标值<1.8 mmol/L和非高密度脂蛋白胆固醇目标值<2.6 mmol/L。非高密度脂蛋白胆固醇目标达成率在甘油三酯浓度较高时下降；从图表上看，这种关系似乎与甘油三酯浓度呈持续负相关。相比之下，低密度脂蛋白胆固醇目标达成率与甘油三酯水平在约2.5 mmol/L之前呈负相关且持续相关，之后图表显示趋于平稳，即甘油三酯水平超过2.5 mmol/L后，低密度脂蛋白胆固醇水平没有进一步差异。随着甘油三酯浓度升高，非高密度脂蛋白胆固醇持续增加，高密度脂蛋白胆固醇最初下降但随后趋于平稳（男性为1.5 - 2.0 mmol/L，女性为2.0 - 2.5 mmol/L），低密度脂蛋白胆固醇水平在约2.0 - 2.5 mmol/L时趋于平稳，TRL - 胆固醇（非高密度脂蛋白胆固醇减去低密度脂蛋白胆固醇）持续上升。在多变量调整模型中，甘油三酯浓度升高、非专科护理和血压控制不佳与非高密度脂蛋白胆固醇目标达成率呈负相关。甘油三酯水平与非高密度脂蛋白胆固醇目标达成率的相关性比与低密度脂蛋白胆固醇目标达成率的相关性更强（对数甘油三酯每增加1个标准差，低密度脂蛋白胆固醇目标达成率的比值比为0.74，95%置信区间为0.61 - 0.89；非高密度脂蛋白胆固醇目标达成率的比值比为0.49，95%置信区间为0.38 - 0.61）。
糖尿病合并心血管疾病患者的非高密度脂蛋白胆固醇目标达成情况不理想。在甘油三酯水平较高时最为明显，可能是由于TRL水平较高。
