Inyaku Masafumi, Tanaka Marenao, Sato Tatsuya, Endo Keisuke, Mori Kazuma, Hosaka Itaru, Mikami Takuma, Umetsu Araya, Ohnishi Hirofumi, Akiyama Yukinori, Hanawa Nagisa, Furuhashi Masato
Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine.
Tanaka Medical Clinic.
J Atheroscler Thromb. 2024 Mar 1;31(3):232-248. doi: 10.5551/jat.64369. Epub 2023 Aug 30.
A high level of directly measured small dense low-density lipoprotein cholesterol (sdLDL-C) is a strong risk factor for ischemic heart disease (IHD). However, it remains unclear whether estimated sdLDL-C level is a predictor for IHD. We investigated the associations of new onset of IHD with levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), LDL-C and calculated sdLDL-C by Sampson's equation.
After exclusion of subjects with IHD or those with TG ≥ 800 mg/dL, a total of 18,176 subjects (men/women: 11,712/6,464, mean age: 46 years) were recruited among 28,990 Japanese individuals who received annual health checkups.
During the 10-year follow-up period, 456 men (3.9%) and 121 women (1.9%) newly developed IHD. Multivariable Cox proportional hazard analyses after adjustment of age, sex, obesity, smoking habit, family history of IHD, estimated glomerular filtration rate, hypertension and diabetes mellitus at baseline showed that the hazard ratio (HR) (1.38 [95% confidence interval: 1.03-1.85]) for new onset of IHD in subjects with the 4 quartile (Q4) of sdLDL-C (≥ 42 mg/dL) was significantly higher than that in subjects with the 1 quartile (Q1) (≤ 24 mg/dL) as the reference, though the adjusted HRs in subjects with Q2-Q4 of TC, HDL-C, non-HDL-C, LDL-C and TG were comparable with those in subjects with Q1 of the respective lipid fractions. The adjusted HR with a restricted cubic spline increased with a higher level of calculated sdLDL-C as a continuous value at baseline.
sdLDL-C level calculated by Sampson's equation is a predominant predictor for the development of IHD in a general Japanese population.
直接测量的高水平小而密低密度脂蛋白胆固醇（sdLDL-C）是缺血性心脏病（IHD）的一个强风险因素。然而，估计的sdLDL-C水平是否为IHD的预测指标仍不清楚。我们通过桑普森方程研究了IHD新发与总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、非HDL-C、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）水平以及计算得出的sdLDL-C之间的关联。
在排除患有IHD或TG≥800mg/dL的受试者后，在28990名接受年度健康检查的日本个体中招募了总共18176名受试者（男性/女性：11712/6464，平均年龄：46岁）。
在10年随访期内，456名男性（3.9%）和121名女性（1.9%）新发IHD。在对年龄、性别、肥胖、吸烟习惯、IHD家族史、估计肾小球滤过率、高血压和糖尿病进行基线调整后的多变量Cox比例风险分析显示，sdLDL-C处于第4四分位数（Q4）（≥42mg/dL）的受试者发生IHD的风险比（HR）（1.38[95%置信区间：(1.03 - 1.85)]）显著高于以第1四分位数（Q1）（≤24mg/dL）为参照的受试者，尽管TC、HDL-C、非HDL-C、LDL-C和TG处于Q2 - Q4的受试者的调整后HR与各自脂质组分处于Q1的受试者相当。基线时，作为连续变量，采用受限立方样条的调整后HR随着计算得出的sdLDL-C水平升高而增加。
通过桑普森方程计算得出的sdLDL-C水平是日本普通人群发生IHD的主要预测指标。
