Bahulikar Arun, Tickoo Vidya, Phalgune Deepak
Consultant Physician, Poona Hospital and Research Centre, Pune, Maharashtra.
Senior Resident,Poona Hospital and Research Centre, Pune, Maharashtra.
J Assoc Physicians India. 2018 Aug;66(8):22-25.
The role of Low Density Lipoprotein Cholesterol (LDL-C) in the pathogenesis of Coronary Heart Disease (CHD) has been well established. In many studies it was found that Non-HDL cholesterol (total cholesterol minus High Density Lipoprotein Cholesterol [HDL-C] is a better predictor of CHD risk than LDL-C alone. High homocysteine levels are associated with increased risk of cardiovascular and cerebrovascular disease. An inverse relation has been seen between vitamin D serum level and coronary artery calcification. Studies are inadequate among Indians to establish the role of these non-conventional risk factors in acute coronary syndrome.
To correlate the values of non-HDL cholesterol, vitamin D and homocysteine in patients with acute coronary syndrome (ACS) with controls.
:For this retrospective study cases were the patients admitted in Poona Hospital and Research Centre between November 2013 and November 2015 with acute coronary syndrome whereas controls were patients admitted in Poona Hospital and Research Centre during the same period with diagnosis other than Acute coronary syndrome. Each patient was subjected to detailed clinical history, clinical examination and investigations such as lipid profile, serum homocysteine, and Vitamin D3. Unpaired t-test was used to compare the quantitative data whereas Chi-square test or Fisher's exact test was used for qualitative data.
ACS group had significantly higher mean total serum cholesterol, mean LDL cholesterol, mean non-HDL cholesterol, and mean plasma homocysteine as compared to control group. However, there was no statistically significant difference between the two groups in Vit D levels. Odds ratio was maximum for Non HDL cholesterol, followed by LDL cholesterol, HDL cholesterol, Serum Homocysteine, and Total cholesterol.
Non-HDL cholesterol was a better predictor of cardiovascular diseases than LDL-C, HDL-C or total cholesterol.
低密度脂蛋白胆固醇（LDL-C）在冠心病（CHD）发病机制中的作用已得到充分证实。许多研究发现，非高密度脂蛋白胆固醇（总胆固醇减去高密度脂蛋白胆固醇[HDL-C]）比单独的LDL-C更能预测冠心病风险。高同型半胱氨酸水平与心血管和脑血管疾病风险增加有关。血清维生素D水平与冠状动脉钙化之间存在负相关关系。在印度人中，关于这些非传统危险因素在急性冠脉综合征中的作用的研究尚不充分。
比较急性冠脉综合征（ACS）患者与对照组中非高密度脂蛋白胆固醇、维生素D和同型半胱氨酸的值。
在这项回顾性研究中，病例为2013年11月至2015年11月在浦那医院和研究中心因急性冠脉综合征入院的患者，而对照组为同期在浦那医院和研究中心入院、诊断为非急性冠脉综合征的患者。对每位患者进行详细的临床病史、临床检查以及血脂谱、血清同型半胱氨酸和维生素D3等检查。采用非配对t检验比较定量数据，而采用卡方检验或Fisher精确检验比较定性数据。
与对照组相比，ACS组血清总胆固醇、LDL胆固醇、非HDL胆固醇和血浆同型半胱氨酸的平均水平显著更高。然而，两组间维生素D水平无统计学显著差异。非HDL胆固醇的比值比最高，其次是LDL胆固醇、HDL胆固醇、血清同型半胱氨酸和总胆固醇。
非HDL胆固醇比LDL-C、HDL-C或总胆固醇更能预测心血管疾病。
