Tashiro Kohei, Inoue Hiroko, Shiga Yuhei, Tsukihashi Yohei, Imaizumi Tomoki, Norimatsu Kenji, Idemoto Yoshiaki, Kuwano Takashi, Sugihara Makoto, Nishikawa Hiroaki, Katsuda Yousuke, Miura Shin-Ichiro
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
These authors contributed equally to this manuscript.
J Clin Med Res. 2020 Nov;12(11):734-739. doi: 10.14740/jocmr4367. Epub 2020 Nov 3.
Although a recent study in a Japanese cohort indicated that extremely high-density lipoprotein cholesterol (HDL-C, ≥ 90 mg/dL) had an adverse effect on atherosclerotic cardiovascular disease mortality, we could not conclude that high levels of HDL-C were associated with the presence or severity of coronary artery disease (CAD).
We enrolled 1,016 patients who were clinically suspected to have CAD and who underwent coronary computed tomography angiography (CCTA). The number of significantly stenosed coronary vessels (vessel disease (VD), ≥ 50% coronary stenosis is diagnosed as CAD) and the Gensini score were quantified using CCTA, and the lipid profile was measured. The patients were divided into four groups according to the HDL-C level: < 40 mg/dL (n = 115, low), 40 - 59 mg/dL (n = 530, normal), 60 - 89 mg/dL (n = 335, high) and ≥ 90 mg/dL (n = 36, very-high).
The percentage (%) of CAD in the low, normal, high and very-high groups was 69%, 55%, 42% and 25%, respectively (P for trend < 0.01). The Gensini score in the low, normal, high and very-high groups was 20 ± 25, 12 ± 16, 8 ± 12 and 4 ± 6, respectively (P for trend < 0.01). The very-high group showed the lowest triglyceride (TG) levels among the four groups. There were no significant differences in the level of low-density lipoprotein cholesterol or % use of statin among the four groups. Finally, the presence of CAD was independently associated with a low level of HDL-C, in addition to age, male, high systolic blood pressure and hemoglobin A1c, but not TG, by a multivariate logistic regression analysis.
High levels of HDL-C at the time of CCTA for screening were associated with a reduced presence and severity of CAD.
尽管最近一项针对日本队列的研究表明，极高密度脂蛋白胆固醇（HDL-C，≥90mg/dL）对动脉粥样硬化性心血管疾病死亡率有不良影响，但我们无法得出HDL-C水平升高与冠状动脉疾病（CAD）的存在或严重程度相关的结论。
我们纳入了1016例临床怀疑患有CAD且接受冠状动脉计算机断层扫描血管造影（CCTA）的患者。使用CCTA对显著狭窄的冠状动脉血管数量（血管疾病（VD），≥50%的冠状动脉狭窄被诊断为CAD）和Gensini评分进行量化，并测量血脂谱。根据HDL-C水平将患者分为四组：<40mg/dL（n = 115，低）、40 - 59mg/dL（n = 530，正常）、60 - 89mg/dL（n = 335，高）和≥90mg/dL（n = 36，极高）。
低、正常、高和极高组中CAD的百分比分别为69%、55%、42%和25%（趋势P<0.01）。低、正常、高和极高组的Gensini评分分别为20±25、12±16、8±12和4±6（趋势P<0.01）。极高组在四组中甘油三酯（TG）水平最低。四组之间低密度脂蛋白胆固醇水平或他汀类药物的使用百分比无显著差异。最后，通过多因素逻辑回归分析，除年龄、男性、高收缩压和糖化血红蛋白A1c外，CAD的存在与低水平的HDL-C独立相关，而与TG无关。
在进行CCTA筛查时，高水平的HDL-C与CAD的存在和严重程度降低相关。
