Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, USA.
Department of Medicine, Albert Einstein College of Medicine, USA.
Eur J Prev Cardiol. 2020 Oct;27(15):1597-1605. doi: 10.1177/2047487319862401. Epub 2019 Jul 10.
The total cholesterol (TC)/high-density lipoprotein (HDL) cholesterol ratio may carry additional information not available in more commonly used single cholesterol measures. Analysis of discordance between lipid parameters might help assess the impact of such additional information on the risk of atherosclerotic cardiovascular disease. We aimed to investigate the role of the TC/HDL-cholesterol ratio in determining atherosclerotic cardiovascular disease risk when discordant with low-density lipoprotein (LDL) cholesterol and non-HDL-cholesterol.
We studied 14,403 Atherosclerosis Risk in Communities (ARIC) study participants who were free of atherosclerotic cardiovascular disease at baseline. TC/HDL-cholesterol discordance with LDL-cholesterol (estimated by the novel Martin/Hopkins method) and non-HDL-cholesterol was assessed at five visits and determined by being at or above the median for each lipid parameter. We constructed Cox proportional hazard models to estimate the risk for incident atherosclerotic cardiovascular disease events associated with each lipid concordance/discordance category using a time-varying approach.
Mean age of participants was 54.1 years, 56% women and 25% black. There were 2634 atherosclerotic cardiovascular disease events over a median (interquartile range) follow-up of 24.2 (16.0-25.4) years. Among individuals with LDL-cholesterol and non-HDL-cholesterol less than the median, 26% and 21% had discordant TC/HDL-cholesterol at or above the median, respectively. These individuals had a 24% (hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.09, 1.41) and 29% (HR 1.29, 95% CI 1.13, 1.46) greater risk of incident atherosclerotic cardiovascular disease, respectively, compared to those with TC/HDL-cholesterol less than the median after multivariable adjustment. In individuals with diabetes with LDL-cholesterol or non-HDL-cholesterol less than the median, discordant TC/HDL-cholesterol at or above the median was more prevalent at 48% and 38%, respectively.
Clinically significant discordance exists between TC/HDL-cholesterol, available from the standard lipid profile, and the routinely used non-HDL-cholesterol and LDL-cholesterol. Such discordance may help inform atherosclerotic cardiovascular disease risk management, particularly in individuals with diabetes in whom discordance is more common.
总胆固醇（TC）/高密度脂蛋白（HDL）胆固醇比值可能提供更常用的单一胆固醇指标中无法获得的额外信息。分析脂质参数之间的差异可能有助于评估这种额外信息对动脉粥样硬化性心血管疾病风险的影响。我们旨在研究当与低密度脂蛋白（LDL）胆固醇和非高密度脂蛋白胆固醇不一致时，TC/HDL-胆固醇比值在确定动脉粥样硬化性心血管疾病风险方面的作用。
我们研究了 14403 名无动脉粥样硬化性心血管疾病病史的 Atherosclerosis Risk in Communities（ARIC）研究参与者。使用新的 Martin/Hopkins 方法评估 TC/HDL-胆固醇与 LDL-胆固醇（通过新型 Martin/Hopkins 方法估计）和非高密度脂蛋白胆固醇之间的差异，并根据每个脂质参数的中位数将其确定为高于或等于中位数。我们使用时间变化方法构建 Cox 比例风险模型，以估计与每种脂质一致性/不一致性类别相关的新发动脉粥样硬化性心血管疾病事件的风险。
参与者的平均年龄为 54.1 岁，56%为女性，25%为黑人。在中位（四分位距）24.2（16.0-25.4）年的随访中，共发生了 2634 例动脉粥样硬化性心血管疾病事件。在 LDL-胆固醇和非高密度脂蛋白胆固醇低于中位数的人群中，分别有 26%和 21%的 TC/HDL-胆固醇高于或等于中位数。与 TC/HDL-胆固醇低于中位数的个体相比，这些个体发生新发动脉粥样硬化性心血管疾病的风险分别增加了 24%（风险比（HR）1.24，95%置信区间（CI）1.09，1.41）和 29%（HR 1.29，95%CI 1.13，1.46）。在 LDL-胆固醇或非高密度脂蛋白胆固醇低于中位数的糖尿病患者中，TC/HDL-胆固醇高于或等于中位数的不一致更为常见，分别为 48%和 38%。
TC/HDL-胆固醇与常规使用的非高密度脂蛋白胆固醇和 LDL-胆固醇之间存在显著的临床不一致。这种不一致可能有助于告知动脉粥样硬化性心血管疾病的风险管理，特别是在 TC/HDL-胆固醇不一致更为常见的糖尿病患者中。
