Wijeysundera Harindra C, Koh Maria, Alter David A, Austin Peter C, Jackevicius Cynthia A, Tu Jack V, Ko Dennis T
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Open Heart. 2017 Dec 17;4(2):e000731. doi: 10.1136/openhrt-2017-000731. eCollection 2017.
Emerging evidence has questioned the role of high-density lipoprotein cholesterol (HDL-C) as an independent and modifiable risk factor for cardiovascular disease. We sought to understand the relationship between HDL-C levels and subsequent non-fatal clinical events.
Individuals without prior cardiovascular disease or cancer were identified. Outcomes of interest were classified as non-fatal cardiovascular, cancer and infectious. Sex-stratified, multivariable, cause-specific Cox proportional hazards models were created. The reference level HDL-C for both women and men was 51-60 mg/dL.
Our cohort consisted of 631 762 individuals. For cardiovascular events, there was a consistent inverse relationship, with higher adjusted HRs for the lower HDL-C strata in both men and women. This relationship was also seen in the composite of non-cardiovascular outcomes. In women, the HR in the <30 mg/dL HDL-C category was 2.10 (95% CI 1.66 to 2.57) and 1.86 (95% CI 1.27 to 2.72) for cardiovascular and non-cardiovascular outcomes, respectively; in contrast, in the >90 mg/dL group, it was 0.87 (95% CI 0.74 to 1.02) and 0.81 (95% CI 0.63 to 1.06). For men, HRs were 2.02 (95% CI 1.79 to 2.28) and 1.84 (95% CI 1.47 to 2.31) in the <30 mg/dL HDL-C category for cardiovascular and non-cardiovascular outcomes, respectively, compared with 0.73 (95% CI 0.53 to 1.00) and 1.07 (95% CI 0.67 to 1.70) in the >90 mg/dL group.
We found an inverse relationship between HDL-C and a wide spectrum of non-fatal outcomes, suggesting that HDL-C is a heavily confounded factor that may be a marker of poor overall health, rather than an independent and modifiable risk factor.
新出现的证据对高密度脂蛋白胆固醇（HDL-C）作为心血管疾病独立且可改变的危险因素的作用提出了质疑。我们试图了解HDL-C水平与随后的非致命临床事件之间的关系。
确定无既往心血管疾病或癌症的个体。将感兴趣的结局分为非致命性心血管疾病、癌症和感染性疾病。创建了按性别分层的多变量、特定病因的Cox比例风险模型。女性和男性的HDL-C参考水平均为51 - 60mg/dL。
我们的队列由631762名个体组成。对于心血管事件，存在一致的负相关关系，男性和女性中HDL-C水平越低，调整后的风险比越高。在非心血管结局的综合分析中也观察到了这种关系。在女性中，HDL-C<30mg/dL组中心血管和非心血管结局的风险比分别为2.10（95%CI 1.66至2.57）和1.86（95%CI 1.27至2.72）；相比之下，在HDL-C>90mg/dL组中，分别为0.87（95%CI 0.74至1.02）和0.81（95%CI 0.63至1.06）。对于男性，HDL-C<30mg/dL组中心血管和非心血管结局的风险比分别为2.02（95%CI 1.79至2.28）和1.84（95%CI 1.47至2.31），而在HDL-C>90mg/dL组中分别为0.73（95%CI 0.53至1.00）和1.07（95%CI 0.67至1.70）。
我们发现HDL-C与广泛的非致命结局之间存在负相关关系，这表明HDL-C是一个高度混杂的因素，可能是整体健康状况不佳的标志，而不是一个独立且可改变的危险因素。
