血清反式脂肪酸、不对称二甲基精氨酸与疑似冠心病患者急性心肌梗死风险及死亡率：一项前瞻性队列研究
Serum trans fatty acids, asymmetric dimethylarginine and risk of acute myocardial infarction and mortality in patients with suspected coronary heart disease: a prospective cohort study.
作者信息
Borgeraas Heidi, Hertel Jens Kristoffer, Seifert Reinhard, Berge Rolf K, Bohov Pavol, Ueland Per Magne, Nygård Ottar, Hjelmesæth Jøran
机构信息
Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
出版信息
Lipids Health Dis. 2016 Feb 27;15:38. doi: 10.1186/s12944-016-0204-9.
BACKGROUND
Trans fatty acids (TFAs) have been found to impair flow mediated vasodilation and nitric oxide (NO) production. We sought to examine if serum TFA levels are associated with plasma levels of the NO inhibitor asymmetric dimethylarginine (ADMA) and if possible relationships between serum TFA and cardiovascular morbidity or mortality are mediated or modified by plasma ADMA levels.
METHODS
The cohort included patients who underwent coronary angiography for suspected coronary heart disease in 2000-2001. Serum trans 16:1n7 and trans 18:1 isomers were determined by gas liquid chromatography and the summation of these two TFAs is reported as TFA (percentage by weight (wt%) or concentration). Associations between TFAs and ADMA were estimated by calculating the Spearman's rank correlation coefficient (ρ), and risk associations with AMI, cardiovascular death and all-cause mortality across quartiles of TFAs (wt% or concentration) were explored by Cox modeling.
RESULTS
A total of 1364 patients (75 % men) with median (25(th),75(th) percentile) age 61 (54, 69) years, serum TFA 0.46 (0.36, 0.56) wt% and plasma ADMA 0.59 (0.50, 0.70) μmol/L were studied. Serum TFA levels (ρ = 0.21, p < 0.001), trans 16:1n7 (ρ = 0.22, p < 0.001) and trans 18:1 (ρ = 0.20, p < 0.001) levels were significantly correlated with plasma ADMA levels. During the median (25(th),75(th) percentile) follow-up time of 5.8 (4.5, 6.4) years, 129 (9.5 %) patients experienced an AMI, 124 (9.1 %) died, whereof 66 (53 %) due to cardiovascular causes. After multivariate adjustments no significant associations between serum TFA levels (wt% or concentration) and incident AMI, CV death and all-cause mortality were observed. Similar results were obtained when repeating the analyses with trans 16:1n7 and trans 18:1 individually. Plasma ADMA levels did not significantly modify the associations between TFA levels and outcomes.
CONCLUSIONS
Serum TFA levels were positively correlated with plasma ADMA levels. After multivariate adjustments, TFAs were not associated with incident AMI or mortality, and associations were not influenced by ADMA.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT00354081.
背景
已发现反式脂肪酸（TFA）会损害血流介导的血管舒张和一氧化氮（NO）生成。我们试图研究血清TFA水平是否与NO抑制剂不对称二甲基精氨酸（ADMA）的血浆水平相关，以及血清TFA与心血管发病率或死亡率之间的可能关系是否由血浆ADMA水平介导或改变。
方法
该队列包括2000 - 2001年因疑似冠心病接受冠状动脉造影的患者。通过气液色谱法测定血清反式16:1n7和反式18:1异构体，并将这两种TFA的总和报告为TFA（重量百分比（wt%）或浓度）。通过计算Spearman等级相关系数（ρ）估计TFA与ADMA之间的关联，并通过Cox模型探索TFA四分位数（wt%或浓度）与急性心肌梗死（AMI）、心血管死亡和全因死亡率的风险关联。
结果
共研究了1364例患者（75%为男性），年龄中位数（第25、75百分位数）为61（54, 69）岁，血清TFA为0.46（0.36, 0.56）wt%，血浆ADMA为0.59（0.50, 0.70）μmol/L。血清TFA水平（ρ = 0.21，p < 0.001）、反式16:1n7（ρ = 0.22，p < 0.001）和反式18:1（ρ = 0.20，p < 0.001）水平与血浆ADMA水平显著相关。在中位数（第25、75百分位数）随访时间5.8（4.5, 6.4）年期间，129例（9.5%）患者发生AMI，124例（9.1%）死亡其中66例（53%）死于心血管原因）。多变量调整后，未观察到血清TFA水平（wt%或浓度）与新发AMI、心血管死亡和全因死亡率之间存在显著关联。对反式16:1n7和反式18:1分别重复分析时获得了类似结果。血浆ADMA水平并未显著改变TFA水平与结局之间的关联。
结论
血清TFA水平与血浆ADMA水平呈正相关。多变量调整后，TFA与新发AMI或死亡率无关，且关联不受ADMA影响。
试验注册
Clinicaltrials.gov标识符：NCT00354081。
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