高密度脂蛋白胆固醇与QTc间期的关联：一项基于人群的流行病学研究。
Association Between HDL Cholesterol and QTc Interval: A Population-Based Epidemiological Study.
作者信息
Del Giorno Rosaria, Gabutti Sofia, Troiani Chiara, Stefanelli Kevyn, Falciano Raffaele, Graziano Elisa, Rochat Negro Tommaso, Gabutti Luca
机构信息
Department of Internal Medicine and Nephrology, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland.
Department of Social Sciences and Economics; Sapienza University of Rome, 00185 Rome, Italy.
出版信息
J Clin Med. 2019 Sep 23;8(10):1527. doi: 10.3390/jcm8101527.
Previous experimental studies showed that increasing high-density lipoprotein cholesterol (HDL) cholesterol shortens cardiac ventricular repolarization and the QT interval corrected for heart rate (QTc). However, little is known about the epidemiological relationship between HDL and QTc. The potential antiarrhythmic effect of HDL cholesterol remains a speculative hypothesis. In this cross-sectional population based study in adults living in the Italian-speaking part of Switzerland, we aimed to explore the association between HDL cholesterol and the QTc interval in the general population. A total of 1202 subjects were screened. electrocardiogram (ECG) recordings, measurements of lipid parameters and other laboratory tests were performed. QTc was corrected using Bazett's (QTc) and Framingham (QTc) formulas. HDL was categorized according to percentile distributions: <25th (HDL-1; ≤1.39 mmol/L); 25th-<50th (HDL-2; 1.40-1.69 mmol/L); 50th-<75th (HDL-3; 1.69-1.99 mmol/L); and ≥75th (HDL-4; ≥2.0 mmol/L). After exclusion procedures, data of 1085 subjects were analyzed. Compared with the HDL reference group (HDL-1), HDL-2 and HDL-3 were associated with a reduction of QTc and QTc duration in crude (HDL-2, QTc/QTc: β-11.306/-10.186, SE 4.625/4.016; = 0.016/0.012; HDL-3, β-12.347/-12.048, SE 4.875/4.233, = 0.012/<0.001) and adjusted (HDL-2: β-11.697/-10.908, SE 4.333/4.151, < 0.001/0.010; HDL-3 β-11.786/-11.002, SE 4.719/4.521, = 0.014/0.016) linear regression models in women. In adjusted logistic regression models higher HDL, were also associated with lower risk of prolonged QTc/QTc (HDL-2: OR 0.16/0.17, CI 0.03-0.83/0.47-0.65; HDL-3: OR 0.10/0.14, CI 0.10-0.64/0.03-0.63) in women. Restricted cubic spline analysis confirmed a non linear association ( < 0.001). The present findings indicate an epidemiological association between HDL cholesterol and QTc duration. To draw firm conclusions, further investigations in other populations and with a prospective cohort design are needed.
先前的实验研究表明，提高高密度脂蛋白胆固醇（HDL）水平可缩短心室复极时间以及经心率校正的QT间期（QTc）。然而，HDL与QTc之间的流行病学关系却鲜为人知。HDL胆固醇的潜在抗心律失常作用仍是一个推测性的假说。在这项针对居住在瑞士意大利语区的成年人的横断面人群研究中，我们旨在探究普通人群中HDL胆固醇与QTc间期之间的关联。总共筛查了1202名受试者，并进行了心电图（ECG）记录、血脂参数测量及其他实验室检查。QTc采用Bazett公式（QTc）和弗雷明汉公式（QTc）进行校正。HDL根据百分位数分布进行分类：<第25百分位数（HDL-1；≤1.39 mmol/L）；第25至<第50百分位数（HDL-2；1.40 - 1.69 mmol/L）；第50至<第75百分位数（HDL-3；1.69 - 1.99 mmol/L）；以及≥第75百分位数（HDL-4；≥2.0 mmol/L）。经过排除程序后，对1085名受试者的数据进行了分析。与HDL参照组（HDL-1）相比，在未校正（HDL-2，QTc/QTc：β - 11.306 / - 10.186，标准误4.625 / 4.016；P = 0.016 / 0.012；HDL-3，β - 12.347 / - 12.048，标准误4.875 / 4.233，P = 0.012 / <0.001）和校正（HDL-2：β - 11.697 / - 10.908，标准误4.333 / 4.151，P < 0.001 / 0.010；HDL-3 β - 11.786 / - 11.002，标准误4.719 / 4.521，P = 0.014 / 0.016）的线性回归模型中，HDL-2和HDL-3与女性QTc及QTc时长的缩短相关。在校正后的逻辑回归模型中，较高的HDL水平也与女性QTc/QTc延长风险降低相关（HDL-2：比值比0.16 / 0.17，置信区间0.03 - 0.83 / 0.47 - 0.65；HDL-3：比值比0.10 / 0.14，置信区间0.10 - 0.64 / 0.03 - 0.63）。受限立方样条分析证实了二者存在非线性关联（P < 0.001）。目前的研究结果表明HDL胆固醇与QTc时长之间存在流行病学关联。为得出确切结论，需要在其他人群中进行进一步研究，并采用前瞻性队列设计。
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