Lee Da Young, Kim Ji Hyun, Park Se Eun, Park Cheol-Young, Oh Ki-Won, Park Sung-Woo, Rhee Eun-Jung, Lee Won-Young
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Ansan, South Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Arch Med Res. 2017 Apr;48(3):284-291. doi: 10.1016/j.arcmed.2017.06.005.
Previous studies reported that many patients are at high risk for cardiovascular disease (CVD) despite achieving recommended low-density lipoprotein cholesterol (LDL-C) levels. Therefore, we investigated whether the association between LDL-C and the risk for incident CVD differed according to high-density lipoprotein cholesterol (HDL-C) levels using coronary artery calcium score (CACS) progression as a surrogate marker for predicting CVD.
We investigated 2132 Korean men in a health screening program, in which CACS was measured at baseline and after 4 years. Coronary artery calcification (CAC) progression was defined as a change in CACS ≥0 over 4 years. We divided the subjects into nine groups according to baseline HDL-C and LDL-C levels and compared their risks for CAC progression.
After 4 years, 475 subjects (22.3%) exhibited CAC progression. We identified a positive relationship between baseline LDL-C levels and the risk for incident CAC. However, this association was attenuated by high baseline HDL-C levels. Multivariate logistic regression analysis adjusted for age, body mass index, systolic blood pressure, fasting glucose, smoking, and exercise status revealed that the odds ratios for incident CAC in the lowest HDL-C tertile were 3.08 for LDL-C tertile 3 and 2.02 for LDL-C tertile 2 compared to LDL-C tertile 1. However, these differences disappeared in the highest HDL-C tertile (HDL-C ≥54.0 mg/dL).
In this longitudinal study, we found that the positive relationship between LDL-C and the relative risk for incident CAC was attenuated by higher HDL-C levels. Therefore, HDL-C levels should be considered when estimating CVD risk.
既往研究报道，许多患者尽管已达到推荐的低密度脂蛋白胆固醇（LDL-C）水平，但仍处于心血管疾病（CVD）的高风险中。因此，我们使用冠状动脉钙化积分（CACS）进展作为预测CVD的替代标志物，研究了根据高密度脂蛋白胆固醇（HDL-C）水平，LDL-C与新发CVD风险之间的关联是否存在差异。
我们在一项健康筛查项目中调查了2132名韩国男性，在基线和4年后测量了CACS。冠状动脉钙化（CAC）进展定义为4年内CACS变化≥0。我们根据基线HDL-C和LDL-C水平将受试者分为九组，并比较了他们发生CAC进展的风险。
4年后，475名受试者（22.3%）出现了CAC进展。我们发现基线LDL-C水平与新发CAC风险之间存在正相关。然而，这种关联被高基线HDL-C水平所减弱。在对年龄、体重指数、收缩压、空腹血糖、吸烟和运动状态进行校正的多因素逻辑回归分析中，与LDL-C三分位数1相比，HDL-C最低三分位数中LDL-C三分位数3发生CAC的比值比为3.08，LDL-C三分位数2为2.02。然而，在HDL-C最高三分位数（HDL-C≥54.0mg/dL）中，这些差异消失了。
在这项纵向研究中，我们发现较高的HDL-C水平减弱了LDL-C与CAC新发相对风险之间的正相关。因此，在评估CVD风险时应考虑HDL-C水平。
