美国甘油三酯水平临界的成年人使用他汀类药物后的估计动脉粥样硬化性心血管疾病（ASCVD）风险：2007 - 2014年美国国家健康与营养检查调查（NHANES）结果

Estimated ASCVD risk according to statin use in US adults with borderline triglycerides: Results from National Health and Nutrition Examination Survey (NHANES) 2007-2014.

作者信息

Fan Wenjun, Philip Sephy, Toth Peter P, Granowitz Craig, Nathan D Wong

机构信息

Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, USA.

Amarin Pharma Inc, Bridgewater, NJ, USA.

出版信息

Am J Prev Cardiol. 2020 Sep 8;3:100087. doi: 10.1016/j.ajpc.2020.100087. eCollection 2020 Sep.

DOI:10.1016/j.ajpc.2020.100087

PMID:34327466

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8315641/

Abstract

BACKGROUND

Elevated triglycerides (TGs) are associated with atherosclerotic cardiovascular disease (ASCVD). Despite statin therapy, many US adults have borderline or elevated TG levels. Not characterized is the ASCVD risk associated with borderline TG levels in statin users, including the estimated number of adults who will sustain ASCVD events.

METHODS

We studied 4986 US adults (weighted to 113 million) aged 40-74 from the National Health and Nutrition Examination Surveys 2007-2014. The proportion of persons at low (<5%), borderline (5-<7.5%), intermediate (7.5-<20%), and high (≥20%) 10-year ASCVD risk among those on statins was quantified for low (<70 mg/dL, 70-<100 mg/dL), borderline (100-<135 mg/dL and 135-<150 mg/dL), borderline high (150-<200 mg/dL), and elevated (≥200 mg/dL) TGs. Multiple logistic regression examined these TG categories in relation to high risk status.

RESULTS

Overall, 18.6% of participants had TG < 70 mg/dL, 24.2% TG 70-<100 mg/dL, 22.0% TG 100-<135 mg/dL, 6.2% TG 135-<150 mg/dL, 15.0% TG 150-<200 mg/dL, and 14.0% TG ≥ 200 mg/dL. Mean 10-year ASCVD risk for these groups were 5.6%, 6.9%, 7.8%, 10.3%, 9.6% and 10.8%, respectively (p < 0.0001). One-fifth or more of statin users with TGs over 135 mg/dL were at ≥ 20% 10-year ASCVD risk and ≥60% of persons in all TG groups were at borderline or higher ASCVD risk. Compared to those with TGs <70 mg/dL, multiple logistic regression showed odds ratios of 3.1 to 4.6 (p < 0.05 to p < 0.01) for those in TG groups ≥135 mg/dL in the overall sample, but 3.4 to 8.1 (p < 0.05 to p < 0.01) for those in TG groups of ≥100 mg/dL in statin users, despite adjustment including HDL-C.

CONCLUSION

Many US adults with borderline levels of TGs are at elevated ASCVD risk despite statin therapy, suggesting the need first for greater lifestyle modification efforts, and when indicated, evidence-based therapies known to reduce this residual ASCVD risk.

摘要

背景

甘油三酯（TG）升高与动脉粥样硬化性心血管疾病（ASCVD）相关。尽管接受了他汀类药物治疗，但许多美国成年人的TG水平仍处于临界值或升高状态。他汀类药物使用者中，临界TG水平与ASCVD风险的特征尚不明确，包括预计会发生ASCVD事件的成年人数量。

方法

我们研究了2007 - 2014年美国国家健康与营养检查调查中4986名年龄在40 - 74岁的成年人（加权至1.13亿）。对他汀类药物使用者中低（<5%）、临界（5 - <7.5%）、中等（7.5 - <20%）和高（≥20%）10年ASCVD风险人群的比例，按照低（<70mg/dL、70 - <100mg/dL）、临界（100 - <135mg/dL和135 - <150mg/dL）、临界高（150 - <200mg/dL）和升高（≥200mg/dL）的TG水平进行了量化。多元逻辑回归分析了这些TG类别与高风险状态的关系。

结果

总体而言，18.6%的参与者TG <70mg/dL，24.2%的参与者TG为70 - <100mg/dL，22.0%的参与者TG为100 - <135mg/dL，6.2%的参与者TG为135 - <150mg/dL，15.0%的参与者TG为150 - <200mg/dL，14.0%的参与者TG≥200mg/dL。这些组的平均10年ASCVD风险分别为5.6%、6.9%、7.8%、10.3%、9.6%和10.8%（p <0.0001）。TG超过135mg/dL的他汀类药物使用者中，五分之一或更多的人10年ASCVD风险≥20%，所有TG组中≥60%的人处于临界或更高的ASCVD风险。与TG <70mg/dL的人相比，多元逻辑回归显示，总体样本中TG≥135mg/dL组的比值比为3.1至4.6（p <0.05至p <0.01），但在他汀类药物使用者中，TG≥100mg/dL组的比值比为3.4至8.1（p <0.05至p <0.01），尽管进行了包括高密度脂蛋白胆固醇（HDL - C）在内的调整。