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升高的 LDL 甘油三酯与动脉粥样硬化风险。

Elevated LDL Triglycerides and Atherosclerotic Risk.

机构信息

Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.

出版信息

J Am Coll Cardiol. 2023 Jan 17;81(2):136-152. doi: 10.1016/j.jacc.2022.10.019.

DOI:10.1016/j.jacc.2022.10.019

PMID:36631208

Abstract

BACKGROUND

It is unclear whether elevated low-density lipoprotein (LDL) triglycerides are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD).

OBJECTIVES

This study tested the hypothesis that elevated LDL triglycerides are associated with an increased risk of ASCVD and of each ASCVD component individually.

METHODS

The study investigators used the Copenhagen General Population Study, which measured LDL triglycerides in 38,081 individuals with a direct automated assay (direct LDL triglycerides) and in another 30,208 individuals with nuclear magnetic resonance (NMR) spectroscopy (NMR LDL triglycerides). Meta-analyses aggregated the present findings with previously reported results.

RESULTS

During a median follow-up of 3.0 and 9.2 years, respectively, 872 and 5,766 individuals in the 2 cohorts received a diagnosis of ASCVD. Per 0.1 mmol/L (9 mg/dL) higher direct LDL triglycerides, HRs were 1.26 (95% CI: 1.17-1.35) for ASCVD, 1.27 (95% CI: 1.16-1.39) for ischemic heart disease, 1.28 (95% CI: 1.11-1.48) for myocardial infarction, 1.22 (95% CI: 1.08-1.38) for ischemic stroke, and 1.38 (95% CI: 1.21-1.58) for peripheral artery disease. Corresponding HRs for NMR LDL triglycerides were 1.26 (95% CI: 1.20-1.33), 1.33 (95% CI: 1.25-1.41), 1.41 (95% CI: 1.31-1.52), 1.13 (95% CI: 1.05-1.23), and 1.26 (95% CI: 1.10-1.43), respectively. The foregoing results were not entirely statistically explained by apolipoprotein B levels. In meta-analyses for the highest quartile vs the lowest quartile of LDL triglycerides, random-effects risk ratios were 1.50 (95% CI: 1.35-1.66) for ASCVD (4 studies; 71,526 individuals; 8,576 events), 1.62 (95% CI: 1.37-1.93) for ischemic heart disease (6 studies; 107,538 individuals; 9,734 events), 1.30 (95% CI: 1.13-1.49) for ischemic stroke (4 studies; 78,026 individuals; 4,273 events), and 1.53 (95% CI: 1.29-1.81) for peripheral artery disease (4 studies; 107,511 individuals; 1,848 events).

CONCLUSIONS

Elevated LDL triglycerides were robustly associated with an increased risk of ASCVD and of each ASCVD component individually in 2 prospective cohort studies and in meta-analyses of previous and present studies combined.

摘要

背景

目前尚不清楚升高的低密度脂蛋白（LDL）甘油三酯是否与动脉粥样硬化性心血管疾病（ASCVD）风险增加相关。

目的

本研究旨在检验以下假设，即升高的 LDL 甘油三酯与 ASCVD 风险以及 ASCVD 的各个组成部分的风险增加相关。

方法

研究人员使用哥本哈根普通人群研究，该研究使用直接自动测定法（直接 LDL 甘油三酯）测量了 38081 名个体的 LDL 甘油三酯，使用核磁共振（NMR）光谱法（NMR LDL 甘油三酯）测量了另外 30208 名个体的 LDL 甘油三酯。荟萃分析汇总了本研究的发现和之前报道的结果。

结果

在分别中位随访 3.0 年和 9.2 年期间，2 个队列中分别有 872 名和 5766 名个体被诊断为 ASCVD。与 LDL 甘油三酯最低四分位组相比，直接 LDL 甘油三酯每升高 0.1mmol/L（9mg/dL），ASCVD 的 HR 为 1.26（95%CI：1.17-1.35），缺血性心脏病为 1.27（95%CI：1.16-1.39），心肌梗死为 1.28（95%CI：1.11-1.48），缺血性卒中为 1.22（95%CI：1.08-1.38），外周动脉疾病为 1.38（95%CI：1.21-1.58）。NMR LDL 甘油三酯的相应 HR 为 1.26（95%CI：1.20-1.33）、1.33（95%CI：1.25-1.41）、1.41（95%CI：1.31-1.52）、1.13（95%CI：1.05-1.23）和 1.26（95%CI：1.10-1.43）。上述结果并不能完全由载脂蛋白 B 水平来解释。在 LDL 甘油三酯最高四分位数与最低四分位数的荟萃分析中，随机效应风险比为 1.50（95%CI：1.35-1.66），用于 ASCVD（4 项研究；71526 名参与者；8576 例事件），1.62（95%CI：1.37-1.93）用于缺血性心脏病（6 项研究；107538 名参与者；9734 例事件），1.30（95%CI：1.13-1.49）用于缺血性卒中（4 项研究；78026 名参与者；4273 例事件），1.53（95%CI：1.29-1.81）用于外周动脉疾病（4 项研究；107511 名参与者；1848 例事件）。