Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.
The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.
Clin Chem. 2021 Jan 8;67(1):276-287. doi: 10.1093/clinchem/hvaa290.
Individuals with obesity have higher concentrations of very low-density lipoprotein (VLDL) cholesterol and increased risk of myocardial infarction. We hypothesized that VLDL cholesterol explains a fraction of the excess myocardial infarction risk in individuals with obesity.
We included 29 010 individuals free of myocardial infarction at baseline, nested within 109 751 individuals from the Copenhagen General Population Study. During 10 years of follow-up, 2306 individuals developed myocardial infarction. Cholesterol content in large and small VLDLs, in intermediate-density lipoprotein (IDL), and in LDL was measured directly with nuclear magnetic resonance spectroscopy.
Median concentrations of cholesterol in large and small VLDLs were 0.12 mmol/L (interquartile range [IQR], 0.07-0.20 mmol/L; 4.5 mg/dL [IQR, 2.6-6.9 mg/dL]) and 0.6 mmol/L (IQR, 0.5-0.8 mmol/L; 25 mg/dL [IQR, 20-30 mg/dL]) in individuals with obesity vs 0.06 mmol/L (IQR, 0.03-0.1 mmol/L; 2.2 mg/dL [IQR, 1.1-3.8 mg/dL]), and 0.5 mmol/L (IQR, 0.4-0.6 mmol/L; 20 mg/dL (IQR, 16-25 mg/dL]) in individuals with normal weight; in contrast, concentrations of IDL and LDL cholesterol were similar across body mass index (BMI) categories. Cholesterol in large and small VLDLs combined explained 40% (95% CI, 27%-53%) of the excess risk of myocardial infarction associated with higher BMI. In contrast, IDL and LDL cholesterol did not explain excess risk of myocardial infarction, whereas systolic blood pressure explained 17% (11%-23%) and diabetes mellitus explained 8.6% (3.2%-14%).
VLDL cholesterol explains a large fraction of excess myocardial infarction risk in individuals with obesity. These novel findings support a focus on cholesterol in VLDL for prevention of myocardial infarction and atherosclerotic cardiovascular disease in individuals with obesity.
肥胖个体的极低密度脂蛋白（VLDL）胆固醇浓度较高，心肌梗死风险增加。我们假设 VLDL 胆固醇可以解释肥胖个体中心肌梗死风险增加的一部分原因。
我们纳入了 29010 名基线时无心肌梗死的个体，这些个体嵌套在来自哥本哈根一般人群研究的 109751 名个体中。在 10 年的随访期间，2306 名个体发生了心肌梗死。采用核磁共振光谱法直接测量大、小 VLDL、中间密度脂蛋白（IDL）和 LDL 中的胆固醇含量。
肥胖个体的大、小 VLDL 胆固醇中位数浓度分别为 0.12mmol/L（四分位距 [IQR]，0.07-0.20mmol/L；4.5mg/dL [IQR，2.6-6.9mg/dL]）和 0.6mmol/L（IQR，0.5-0.8mmol/L；25mg/dL [IQR，20-30mg/dL]），而正常体重个体的相应浓度分别为 0.06mmol/L（IQR，0.03-0.1mmol/L；2.2mg/dL [IQR，1.1-3.8mg/dL]）和 0.5mmol/L（IQR，0.4-0.6mmol/L；20mg/dL [IQR，16-25mg/dL]）；而 IDL 和 LDL 胆固醇浓度在体重指数（BMI）类别中相似。大、小 VLDL 胆固醇的总和解释了与较高 BMI 相关的心肌梗死额外风险的 40%（95%CI，27%-53%）。相比之下，IDL 和 LDL 胆固醇不能解释心肌梗死的额外风险，而收缩压解释了 17%（11%-23%），糖尿病解释了 8.6%（3.2%-14%）。
VLDL 胆固醇可以解释肥胖个体中过量心肌梗死风险的一大部分。这些新发现支持将 VLDL 中的胆固醇作为肥胖个体预防心肌梗死和动脉粥样硬化性心血管疾病的重点。
