Department of Health Management, Beijing Xiao Tang Shan Hospital, Beijing, People's Republic of China.
Department of Epidemiology, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
Lipids Health Dis. 2020 Jun 18;19(1):141. doi: 10.1186/s12944-020-01324-5.
BACKGROUND: The discordance of the low-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol (LDL-C/HDL-C) ratio with alterative lipid parameters may explain the inconsistent association of CIMT with the LDL-C/HDL-C ratio. Therefore, this study aimed to explore the associations between LDL-C/HDL-C ratio discordance with alternative lipid parameters and elevated carotid intima-media thickness (CIMT) risk in a large cohort in Beijing, China. METHODS: In total, 13,612 adults who didn't have elevated CIMT at baseline and who participated in at least one follow-up of annual examination between 2009 and 2016 were included in this cohort study. A multivariable Cox regression model was utilized to evaluate the associations of discordance of the LDL-C/HDL-C ratio with TC, TGs, LDL-C and HDL-C with elevated CIMT risk. RESULTS: During 37,999 person-years of follow-up, 2004 individuals (1274 men and 730 women) developed elevated CIMT. Among individuals with normal TC and TGs, 16.6 and 15.2% individuals had a discordantly high LDL-C/HDL-C ratio, respectively, and the risk of elevated CIMT increased by 1.54 (95% CI 1.33, 1.77) and 1.53 (95% CI 1.33, 1.76), respectively, comparing to individuals with a concordantly low LDL-C/HDL-C ratio. A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with LDL-C and HDL-C (P < 0.001). A low LDL-C/HDL-C ratio with discordantly normal HDL-C and high LDL-C (13.2% of individuals) had a 32% (HR = 1.32, 95% CI 1.11, 1.57) higher risk of elevated CIMT than concordantly low LDL-C and normal HDL-C. Sensitivity analysis by excluding CIMT developed in the first 2 years follow-up further confirmed the above results. CONCLUSIONS: A high LDL-C/HDL-C ratio could significantly increase elevated CIMT risk regardless of discordance/concordance with TC, TGs, LDL-C and HDL-C Even a low LDL-C/HDL-C ratio with discordantly high LDL-C and normal HDL-C could also significantly increase CIMT risk. Individuals should maintain both the LDL-C/HDL-C ratio and LDL-C at normal levels to prevent elevated CIMT.
背景：载脂蛋白 B 与高密度脂蛋白胆固醇（LDL-C/HDL-C）比值与替代脂质参数的不一致可能解释了 CIMT 与 LDL-C/HDL-C 比值之间的不一致关联。因此，本研究旨在探讨中国北京一个大型队列中 LDL-C/HDL-C 比值与替代脂质参数之间的不匹配与颈动脉内膜中层厚度（CIMT）升高风险之间的关系。
方法：本队列研究共纳入了 13612 名基线时 CIMT 不升高且在 2009 年至 2016 年期间至少参加了一次年度检查随访的成年人。采用多变量 Cox 回归模型评估 LDL-C/HDL-C 比值与 TC、TGs、LDL-C 和 HDL-C 之间的不匹配与 CIMT 升高风险之间的关系。
结果：在 37999 人年的随访期间，2004 名个体（1274 名男性和 730 名女性）发生了 CIMT 升高。在 TC 和 TGs 正常的个体中，分别有 16.6%和 15.2%的个体 LDL-C/HDL-C 比值不匹配，与 LDL-C/HDL-C 比值一致的个体相比，CIMT 升高的风险分别增加了 1.54（95%CI 1.33，1.77）和 1.53（95%CI 1.33，1.76）。无论 LDL-C/HDL-C 比值是否与 LDL-C 和 HDL-C 不匹配/一致，高 LDL-C/HDL-C 比值均可显著增加 CIMT 升高的风险（P<0.001）。与 LDL-C 一致但 HDL-C 不匹配（13.2%的个体）的低 LDL-C/HDL-C 比值发生 CIMT 升高的风险比 LDL-C 和 HDL-C 均正常的个体高 32%（HR=1.32，95%CI 1.11，1.57）。排除前 2 年随访期间发生的 CIMT 后进行的敏感性分析进一步证实了上述结果。
结论：无论与 TC、TGs、LDL-C 和 HDL-C 是否不匹配/一致，高 LDL-C/HDL-C 比值均可显著增加 CIMT 升高的风险。即使 LDL-C/HDL-C 比值低但 LDL-C 高且 HDL-C 正常，也能显著增加 CIMT 升高的风险。个体应保持 LDL-C/HDL-C 比值和 LDL-C 处于正常水平，以预防 CIMT 升高。
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