高密度脂蛋白颗粒与血管域、性别和种族的缺血性事件之间的关联：一项汇总队列分析。
Associations Between High-Density Lipoprotein Particles and Ischemic Events by Vascular Domain, Sex, and Ethnicity: A Pooled Cohort Analysis.
机构信息
University of Texas Southwestern Medical Center, Dallas (K.S., A.C., T.S., P.H.J., A.K., C.R.A., A.R.).
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.).
出版信息
Circulation. 2020 Aug 18;142(7):657-669. doi: 10.1161/CIRCULATIONAHA.120.045713. Epub 2020 Jun 18.
BACKGROUND
High-density lipoprotein (HDL) cholesterol concentration (HDL-C) is an established atheroprotective marker, in particular for coronary artery disease; however, HDL particle concentration (HDL-P) may better predict risk. The associations of HDL-C and HDL-P with ischemic stroke and myocardial infarction (MI) among women and Blacks have not been well studied. We hypothesized that HDL-P would consistently be associated with MI and stroke among women and Blacks compared with HDL-C.
METHODS
We analyzed individual-level participant data in a pooled cohort of 4 large population studies without baseline atherosclerotic cardiovascular disease: DHS (Dallas Heart Study; n=2535), ARIC (Atherosclerosis Risk in Communities; n=1595), MESA (Multi-Ethnic Study of Atherosclerosis; n=6632), and PREVEND (Prevention of Renal and Vascular Endstage Disease; n=5022). HDL markers were analyzed in adjusted Cox proportional hazard models for MI and ischemic stroke.
RESULTS
In the overall population (n=15 784), HDL-P was inversely associated with the combined outcome of MI and ischemic stroke, adjusted for cardiometabolic risk factors (hazard ratio [HR] for quartile 4 [Q4] versus quartile 1 [Q1], 0.64 [95% CI, 0.52-0.78]), as was HDL-C (HR for Q4 versus Q1, 0.76 [95% CI, 0.61-0.94]). Adjustment for HDL-C did not attenuate the inverse relationship between HDL-P and atherosclerotic cardiovascular disease, whereas adjustment for HDL-P attenuated all associations between HDL-C and events. HDL-P was inversely associated with the individual end points of MI and ischemic stroke in the overall population, including in women. HDL-P was inversely associated with MI among White participants but not among Black participants (HR for Q4 versus Q1 for Whites, 0.49 [95% CI, 0.35-0.69]; for Blacks, 1.22 [95% CI, 0.76-1.98]; =0.001). Similarly, HDL-C was inversely associated with MI among White participants (HR for Q4 versus Q1, 0.53 [95% CI, 0.36-0.78]) but had a weak direct association with MI among Black participants (HR for Q4 versus Q1, 1.75 [95% CI, 1.08-2.83]; <0.0001).
CONCLUSIONS
Compared with HDL-C, HDL-P was consistently associated with MI and ischemic stroke in the overall population. Differential associations of both HDL-C and HDL-P for MI by Black ethnicity suggest that atherosclerotic cardiovascular disease risk may differ by vascular domain and ethnicity. Future studies should examine individual outcomes separately.
背景
高密度脂蛋白（HDL）胆固醇浓度（HDL-C）是一种已确立的抗动脉粥样硬化标志物，特别是对冠状动脉疾病；然而，HDL 颗粒浓度（HDL-P）可能更好地预测风险。HDL-C 和 HDL-P 与女性和黑人缺血性卒中和心肌梗死（MI）之间的关系尚未得到很好的研究。我们假设 HDL-P 与 MI 和卒中的相关性在女性和黑人中始终优于 HDL-C。
方法
我们分析了来自 4 个大型人群研究的个体水平参与者数据，这些研究均无基线动脉粥样硬化性心血管疾病：DHS（达拉斯心脏研究；n=2535）、ARIC（社区动脉粥样硬化风险研究；n=1595）、MESA（动脉粥样硬化多民族研究；n=6632）和 PREVEND（预防肾脏和血管终末期疾病；n=5022）。在调整后的 Cox 比例风险模型中分析了 HDL 标志物与 MI 和缺血性卒中的关系。
结果
在总体人群（n=15784）中，HDL-P 与 MI 和缺血性卒中的复合结局呈负相关，经心血管代谢危险因素校正（四分位 4 [Q4]与四分位 1 [Q1]的 HR，0.64 [95%CI，0.52-0.78]），HDL-C 也是如此（Q4 与 Q1 的 HR，0.76 [95%CI，0.61-0.94]）。调整 HDL-C 并不能减弱 HDL-P 与动脉粥样硬化性心血管疾病之间的负相关关系，而调整 HDL-P 则减弱了 HDL-C 与所有事件之间的所有关联。HDL-P 与总体人群中的 MI 和缺血性卒中的各个终点均呈负相关，包括女性。HDL-P 与白人参与者的 MI 呈负相关，但与黑人参与者的 MI 无关（白人 Q4 与 Q1 的 HR，0.49 [95%CI，0.35-0.69]；黑人，1.22 [95%CI，0.76-1.98]；=0.001）。同样，HDL-C 与白人参与者的 MI 呈负相关（Q4 与 Q1 的 HR，0.53 [95%CI，0.36-0.78]），但与黑人参与者的 MI 呈弱正相关（Q4 与 Q1 的 HR，1.75 [95%CI，1.08-2.83]；<0.0001）。
结论
与 HDL-C 相比，HDL-P 在总体人群中与 MI 和缺血性卒中始终相关。HDL-C 和 HDL-P 对 MI 的相关性因黑人种族而存在差异，这表明动脉粥样硬化性心血管疾病的风险可能因血管域和种族而异。未来的研究应分别检查个体结局。
Zotero 插件