The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Am J Cardiol. 2021 Mar 1;142:59-65. doi: 10.1016/j.amjcard.2020.11.038. Epub 2020 Dec 8.
Epidemiological evidence on the relationship between lipid profile and cardiovascular disease (CVD) events in young adults remains insufficient. Thus, we sought to explore the association of lipid profile with subsequent CVD among young adults. Medical records of 1,451,997 young adults (20 to 49 years old) without prior history of CVD and not taking lipid lowering medications were extracted from the Japan Medical Data Center, a nationwide epidemiological database. We conducted multivariable Cox regression analyses to identify the association between lipid profile and the subsequent risk of CVD and used multiple imputation for missing data on body mass index, waist circumference, hypertension, diabetes mellitus, and cigarette smoking in our database. The mean age was 39.0 ± 7.4 years, and 58.5% were men. After a mean follow-up of 1,148 ± 893 days, myocardial infarction, angina pectoris, stroke, and heart failure developed in 1,638 (0.1%), 15,887 (1.1%), 5,593 (0.4%), and 14,351 (1.0%) subjects, respectively. Multivariable Cox regression analyses including covariates after multiple imputation for missing values demonstrated that LDL-C ≥ 140 mg/dL, HDL-C < 40 mg/dL, and triglycerides ≥ 150 mg/dL were independently associated with the incidence of myocardial infarction, angina pectoris, and heart failure. However, they were not associated with the incidence of stroke. Multivariable Cox regression analyses including the number of abnormal lipid profiles and covariates showed that the incidence of myocardial infarction, angina, and heart failure increased stepwise with the number of abnormal lipid profiles. However, the number of abnormal lipid profiles was not associated with the subsequent risk of stroke. In conclusion, the comprehensive analysis of a nationwide epidemiological database demonstrated a close relationship between lipid profile and subsequent CVD, suggesting the importance of maintaining an optimal lipid profile for the primary prevention of CVD in young generations.
关于血脂谱与年轻人心血管疾病 (CVD) 事件之间关系的流行病学证据仍然不足。因此，我们试图探讨血脂谱与年轻人随后发生 CVD 的关系。从日本医学数据中心（一个全国性的流行病学数据库）提取了 1451997 名无 CVD 既往史且未服用降脂药物的年轻成年人（20 至 49 岁）的病历。我们进行了多变量 Cox 回归分析，以确定血脂谱与随后 CVD 风险之间的关系，并在我们的数据库中使用多重插补法填补体重指数、腰围、高血压、糖尿病和吸烟的缺失数据。平均年龄为 39.0±7.4 岁，58.5%为男性。平均随访 1148±893 天后，1638 名（0.1%）、15887 名（1.1%）、5593 名（0.4%）和 14351 名（1.0%）患者分别发生心肌梗死、心绞痛、卒中和心力衰竭。包括缺失值多重插补后协变量的多变量 Cox 回归分析表明，LDL-C≥140mg/dL、HDL-C<40mg/dL 和甘油三酯≥150mg/dL 与心肌梗死、心绞痛和心力衰竭的发生率独立相关。然而，它们与卒中的发生率无关。包括异常血脂谱数量和协变量的多变量 Cox 回归分析表明，随着异常血脂谱数量的增加，心肌梗死、心绞痛和心力衰竭的发生率呈阶梯式增加。然而，异常血脂谱数量与随后发生卒中的风险无关。总之，对全国性流行病学数据库的综合分析表明，血脂谱与随后发生的 CVD 之间存在密切关系，这表明在年轻一代中保持最佳血脂谱对于 CVD 的一级预防非常重要。
