Division of Cardiology, Kaiser Permanente Northern California, Oakland, Calif; Department of Medicine, University of California, San Francisco; Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
Division of Research, Kaiser Permanente Northern California, Oakland, Calif.
Am J Med. 2020 Feb;133(2):200-206. doi: 10.1016/j.amjmed.2019.07.003. Epub 2019 Jul 22.
The relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and risk of incident atherosclerotic cardiovascular disease events among patients with diabetes and metabolic dyslipidemia has not been well described.
We conducted an observational cohort study of statin-treated adults (ages 21-90 years) with type 2 diabetes without established atherosclerotic cardiovascular disease (as of January 1, 2006) who had metabolic dyslipidemia (elevated triglycerides ≥150 mg/dL and low high-density lipoprotein cholesterol, <50 mg/dL [women] and <40 mg/dL [men]). All subjects were members of Kaiser Permanente Northern California, an integrated health care delivery system. Adjusted multivariable Cox models were specified to estimate hazard ratios (HRs) for incident atherosclerotic cardiovascular disease events by achieved LDL-C levels (<50, 50-<70, 70-<100, and ≥100 mg/dL). Incident atherosclerotic cardiovascular disease events were defined as a composite of nonfatal myocardial infarction, ischemic stroke, or coronary heart disease death through December 31, 2013.
A total of 19,095 individuals met the selection criteria. Mean age was 63.4 years, 53.5% were women, and the mean follow-up was 5.9 years. Unadjusted rates of atherosclerotic cardiovascular disease events were not significantly different across specified LDL-C categories. In models adjusted for demographics and clinical characteristics, the risk was significantly lower with decreasing achieved LDL-C levels (P <0.0001 for trend). Relative to achieved LDL-C ≥100 mg/dL, LDL-C <50 mg/dL had an hazard ratio of 0.66 (95% confidence interval [CI] 0.52-0.82).
In a large, contemporary cohort of statin-treated patients with type 2 diabetes and metabolic dyslipidemia without established atherosclerotic cardiovascular disease, lower achieved LDL-C levels were associated with a monotonically lower risk of incident atherosclerotic cardiovascular disease events. The benefits of achieving very-low LDL-C (<50 mg/dL) in this population requires further evaluation in prospective interventional studies.
患有糖尿病和代谢性血脂异常的患者，其达到的低密度脂蛋白胆固醇（LDL-C）水平与动脉粥样硬化性心血管疾病事件的发生风险之间的关系尚未得到充分描述。
我们进行了一项观察性队列研究，纳入了接受他汀类药物治疗的 21-90 岁成年人（截至 2006 年 1 月 1 日，尚未患有动脉粥样硬化性心血管疾病），这些患者患有代谢性血脂异常（甘油三酯升高≥150mg/dL，高密度脂蛋白胆固醇降低，女性<50mg/dL，男性<40mg/dL）。所有受试者均为 Kaiser Permanente Northern California 的成员，这是一个综合医疗服务提供系统。指定了调整后的多变量 Cox 模型，以按达到的 LDL-C 水平（<50、50-<70、70-<100 和≥100mg/dL）估计发生动脉粥样硬化性心血管疾病事件的风险比（HR）。发生动脉粥样硬化性心血管疾病事件的定义为非致死性心肌梗死、缺血性卒中和冠心病死亡的复合终点，截至 2013 年 12 月 31 日。
共有 19095 人符合入选标准。平均年龄为 63.4 岁，53.5%为女性，平均随访时间为 5.9 年。在指定的 LDL-C 类别中，未经调整的动脉粥样硬化性心血管疾病事件发生率没有显著差异。在调整了人口统计学和临床特征的模型中，随着达到的 LDL-C 水平降低，风险显著降低（趋势 P<0.0001）。与达到的 LDL-C≥100mg/dL 相比，LDL-C<50mg/dL 的风险比为 0.66（95%置信区间[CI]0.52-0.82）。
在一个大型的、当代的他汀类药物治疗的 2 型糖尿病和代谢性血脂异常患者队列中，没有明确的动脉粥样硬化性心血管疾病，较低的 LDL-C 水平与事件发生率较低的动脉粥样硬化性心血管疾病风险相关。在这一人群中，实现极低 LDL-C（<50mg/dL）的获益需要进一步在前瞻性干预性研究中进行评估。
