血脂谱的分层建模与10年（2002 - 2012年）全因死亡率及心血管疾病发病率：阿提卡研究
Hierarchical modelling of blood lipids' profile and 10-year (2002-2012) all cause mortality and incidence of cardiovascular disease: the ATTICA study.
作者信息
Nomikos Tzortzis, Panagiotakos Demosthenes, Georgousopoulou Ekavi, Metaxa Vassiliki, Chrysohoou Christina, Skoumas Ioannis, Antonopoulou Smaragdi, Tousoulis Dimitrios, Stefanadis Christodoulos, Pitsavos Christos
机构信息
Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
, 46 Paleon Polemiston St., Glyfada, Attica, 166 74, Greece.
出版信息
Lipids Health Dis. 2015 Sep 15;14:108. doi: 10.1186/s12944-015-0101-7.
BACKGROUND
The traditional view on the relationship between lipid biomarkers and CVD risk has changed during the last decade. However, it is not clear whether novel lipid biomarkers are able to confer a better predictability of CVD risk, compared to traditional ones.Under this perspective, the aim of the present work was to evaluate the predictive ability of blood lipids' profile on all cause mortality as well as 10-year incidence of CVD, in a sample of apparently healthy adults of the ATTICA epidemiological study.
METHODS
From May 2001 to December 2002, 1514 men and 1528 women (>18 y) without any clinical evidence of any other chronic disease, at baseline, were enrolled. In 2011-12, the 10-year follow-up was performed in 2583 participants (85 % follow-up participation rate). Incidence of fatal or non-fatal CVD was defined according to WHO-ICD-10 criteria. Baseline serum blood lipids' profile (Total-C, HDL-, non HDL-, LDL-cholesterol, triglycerides (TG), apolipoprotein (Apo)A1 and B, and lipoprotein-(a) levels were also measured.
RESULTS
The 10-year all-cause mortality rate was 5.7 % for men and 2.0 % for women (p = 0.55). The, 10-year CVD incidence was 19.7 % in men and 11.7 % in women (p < 0.001). Multi-adjusted analysis revealed that TC, non-HDL-C, TG and TG/HDL-C ratio, were independent predictors of all cause mortality (RR per 1 mg/dL or unit (95 % CI): 1.006 (1.000-1.013), 1.006 (1.000-1.013), 1.002 (1.000-1.004), 1.038 (1.001-1.077), respectively). Moreover, TC, HDL-, LDL-, non-HDL-cholesterol, TG, apoA1, TC/HDL-C and TG/HDL-C were independently associated with CVD risk. Among all lipid indices the ratio of apoB/apoA1 demonstrated the best correct reclassification ability, followed by non-HDL-C and TC/HDL-C ratio (continuous Net Reclassification Index 26.1 and 21.2 %, respectively).
CONCLUSION
Elevated levels of lipid biomarkers are independently associated with all-cause mortality, as well as CVD risk. The ratio of apoB/apoA1, followed by non-HDL-C, demonstrated the best correct classification ability of the developed CVD risk models.
背景
在过去十年中，关于脂质生物标志物与心血管疾病（CVD）风险之间关系的传统观点发生了变化。然而，与传统脂质生物标志物相比，新型脂质生物标志物是否能够更好地预测CVD风险尚不清楚。在此背景下，本研究旨在评估雅典流行病学研究中一组看似健康的成年人样本的血脂谱对全因死亡率以及10年CVD发病率的预测能力。
方法
2001年5月至2002年12月，纳入了1514名男性和1528名女性（年龄>18岁），这些人在基线时无任何其他慢性病的临床证据。2011 - 2012年，对2583名参与者进行了10年随访（随访参与率为85%）。根据世界卫生组织国际疾病分类第10版（WHO - ICD - 10）标准定义致命或非致命CVD的发病率。同时还测量了基线血清血脂谱（总胆固醇（Total - C）、高密度脂蛋白胆固醇（HDL - ）、非高密度脂蛋白胆固醇（non HDL - ）、低密度脂蛋白胆固醇（LDL - ）、甘油三酯（TG）、载脂蛋白（Apo）A1和B以及脂蛋白（a）水平）。
结果
男性10年全因死亡率为5.7%，女性为2.0%（p = 0.55）。男性10年CVD发病率为19.7%，女性为11.7%（p < 0.001）。多因素校正分析显示，总胆固醇、非高密度脂蛋白胆固醇、甘油三酯和甘油三酯/高密度脂蛋白胆固醇比值是全因死亡率的独立预测因素（每1mg/dL或单位的相对风险（RR）（95%置信区间）：分别为1.006（1.000 - 1.013）、1.006（1.000 - 1.013）、1.002（1.000 - 1.004）、1.038（1.001 - 1.077））。此外，总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、甘油三酯、载脂蛋白A1、总胆固醇/高密度脂蛋白胆固醇和甘油三酯/高密度脂蛋白胆固醇与CVD风险独立相关。在所有脂质指标中，载脂蛋白B/载脂蛋白A1比值显示出最佳的正确重新分类能力，其次是非高密度脂蛋白胆固醇和总胆固醇/高密度脂蛋白胆固醇比值（连续净重新分类指数分别为26.1%和21.2%）。
结论
脂质生物标志物水平升高与全因死亡率以及CVD风险独立相关。载脂蛋白B/载脂蛋白A1比值，其次是非高密度脂蛋白胆固醇，在已建立的CVD风险模型中显示出最佳的正确分类能力。
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