Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
J Am Coll Cardiol. 2016 Nov 8;68(19):2073-2083. doi: 10.1016/j.jacc.2016.08.038.
The prognostic importance of high-density lipoprotein cholesterol (HDL-C) as a specific risk factor for cardiovascular (CV) disease has been challenged by recent clinical trials and genetic studies.
This study sought to reappraise the association of HDL-C level with CV and non-CV mortality using a "big data" approach.
An observational cohort study was conducted using the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) dataset, which was created by linking together 17 different individual-level data sources. People were included if they were between 40 and 105 years old on January 1, 2008, living in Ontario, Canada, without previous CV conditions or severe comorbidities, and had an outpatient fasting cholesterol measurement in the year prior to the inception date. The primary outcome was cause-specific mortality.
A total of 631,762 individuals were included. The mean age of our cohort was 57.2 years, 55.4% were women, and mean HDL-C level was 55.2 mg/dl. There were 17,952 deaths during a mean follow-up of 4.9 ± 0.4 years. The overall all-cause mortality rate was 8.1 per 1,000 person-years for men and 6.6 per 1,000 person-years for women. Individuals with lower HDL-C levels were more likely to have low incomes, unhealthy lifestyle, higher triglycerides levels, other cardiac risk factors, and medical comorbidities. Individuals with lower HDL-C levels were independently associated with higher risk of CV, cancer, and other mortality compared with individuals in the reference ranges of HDL-C levels. In addition, individuals with higher HDL levels (>70 mg/dl in men, >90 mg/dl in women) had increased hazard of non-CV mortality.
Complex associations exist between HDL-C levels and sociodemographic, lifestyle, comorbidity factors, and mortality. HDL-C level is unlikely to represent a CV-specific risk factor given similarities in its associations with non-CV outcomes.
高密度脂蛋白胆固醇（HDL-C）作为心血管疾病（CV）特定风险因素的预后重要性受到了最近临床试验和遗传研究的挑战。
本研究通过“大数据”方法重新评估 HDL-C 水平与 CV 和非 CV 死亡率的相关性。
采用 CANHEART（门诊心血管健康研究团队）数据集进行观察性队列研究，该数据集通过将 17 个不同的个体水平数据源连接在一起创建。如果患者在 2008 年 1 月 1 日年龄在 40 至 105 岁之间，居住在加拿大安大略省，没有既往 CV 疾病或严重合并症，并且在起始日期前的一年中进行了门诊空腹胆固醇测量，则将其纳入研究。主要结局是特定原因的死亡率。
共纳入 631762 人。队列的平均年龄为 57.2 岁，55.4%为女性，平均 HDL-C 水平为 55.2mg/dl。平均随访 4.9±0.4 年后，共有 17952 人死亡。男性全因死亡率为 8.1/1000 人年，女性为 6.6/1000 人年。HDL-C 水平较低的个体更有可能收入较低、生活方式不健康、甘油三酯水平较高、存在其他心脏危险因素和合并症。与 HDL-C 水平参考范围内的个体相比，HDL-C 水平较低的个体发生 CV、癌症和其他死亡的风险更高。此外，HDL 水平较高（男性>70mg/dl，女性>90mg/dl）的个体发生非 CV 死亡的风险增加。
HDL-C 水平与社会人口统计学、生活方式、合并症因素和死亡率之间存在复杂的关联。鉴于 HDL-C 与非 CV 结局的相关性相似，其不太可能代表 CV 特异性风险因素。
