极高的高密度脂蛋白胆固醇水平与男性和女性的高死亡率呈矛盾关系：两项前瞻性队列研究。

Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies.

机构信息

Department of Clinical Biochemistry.

The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark.

出版信息

Eur Heart J. 2017 Aug 21;38(32):2478-2486. doi: 10.1093/eurheartj/ehx163.

DOI:10.1093/eurheartj/ehx163

PMID:28419274

Abstract

AIMS

High-density lipoprotein (HDL) cholesterol concentrations are inversely associated with cardiovascular disease and mortality across a range of concentrations, but genetic evidence suggest that extreme high concentrations may paradoxically lead to more cardiovascular disease. We tested the hypothesis that extreme high concentrations of HDL cholesterol are associated with high all-cause mortality in men and women.

METHODS AND RESULTS

A total of 52 268 men and 64 240 women were included from the two prospective population-based studies, the Copenhagen City Heart Study and the Copenhagen General Population Study. During 745 452 person-years of follow-up, number of deaths from any cause were 5619 (mortality rate, 17.1/1000 person-years (95% confidence interval (CI): 16.7-17.6)) in men and 5059 (mortality rate, 12.1/1000 person-years (11.8-12.4)) in women. The association between HDL cholesterol concentrations and all-cause mortality was U-shaped for both men and women, with both extreme high and low concentrations being associated with high all-cause mortality risk. The concentration of HDL cholesterol associated with the lowest all-cause mortality was 1.9 mmol/L (95% CI: 1.4-2.0) (73 mg/dL (54-77)) in men and 2.4 mmol/L (1.8-2.5) (93 mg/dL (69-97)) in women. When compared with the groups with the lowest risk, the multifactorially adjusted hazard ratios for all-cause mortality were 1.36 (95% CI: 1.09-1.70) for men with HDL cholesterol of 2.5-2.99 mmol/L (97-115 mg/dL) and 2.06 (1.44-2.95) for men with HDL cholesterol ≥3.0 mmol/L (116 mg/dL). For women, corresponding hazard ratios were 1.10 (0.83-1.46) for HDL cholesterol of 3.0-3.49 mmol/L (116-134 mg/dL) and 1.68 (1.09-2.58) for HDL cholesterol ≥3.5 mmol/L (135 mg/dL).

CONCLUSION

Men and women in the general population with extreme high HDL cholesterol paradoxically have high all-cause mortality. These findings need confirmation in other studies.

摘要

目的

高密度脂蛋白（HDL）胆固醇浓度与心血管疾病和死亡率呈负相关，在一系列浓度范围内均如此，但遗传证据表明，极高的浓度可能会导致更多的心血管疾病。我们检验了这样一个假设，即 HDL 胆固醇的极高浓度与男性和女性的全因死亡率高有关。

方法和结果

共有 52268 名男性和 64240 名女性来自两项前瞻性人群为基础的研究，即哥本哈根城市心脏研究和哥本哈根普通人群研究。在 745452 人年的随访期间，男性中有 5619 人（死亡率为 17.1/1000 人年（95%置信区间（CI）：16.7-17.6））死于任何原因，女性中有 5059 人（死亡率为 12.1/1000 人年（11.8-12.4））。男性和女性的 HDL 胆固醇浓度与全因死亡率之间呈 U 形关系，极高和极低浓度都与高全因死亡率风险相关。与全因死亡率最低相关的 HDL 胆固醇浓度在男性中为 1.9mmol/L（95%CI：1.4-2.0）（73mg/dL（54-77）），在女性中为 2.4mmol/L（95%CI：1.8-2.5）（93mg/dL（69-97））。与风险最低的组相比，HDL 胆固醇为 2.5-2.99mmol/L（97-115mg/dL）的男性和 HDL 胆固醇≥3.0mmol/L（116mg/dL）的男性的全因死亡率多因素调整后的危险比分别为 1.36（95%CI：1.09-1.70）和 2.06（1.44-2.95）。对于女性，HDL 胆固醇为 3.0-3.49mmol/L（116-134mg/dL）的女性和 HDL 胆固醇≥3.5mmol/L（135mg/dL）的女性的相应危险比分别为 1.10（0.83-1.46）和 1.68（1.09-2.58）。