Alves-Cabratosa Lia, Guzmán Lidia, Blanch Jordi, Comas-Cufí Marc, García-Gil María, Zacarías-Pons Lluís, Martí-Lluch Ruth, Ponjoan Anna, Domínguez-Armengol Gina, Ribas-Aulinas Francesc, Tornabell-Noguera Èric, García-Ortiz Luis, Ramos Rafel
Grup d'Investigació en Salut Vascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina -IDIAPJGol, C/ Maluquer Salvador, 11, 17002-Girona, Catalonia, Spain.
Network for Research on Chronicity, Primary Care, and Prevention and Health Promotion (RICAPPS), C/ Maluquer Salvador, 11, 17002, Girona, Spain.
Am J Prev Cardiol. 2025 Jul 21;23:101059. doi: 10.1016/j.ajpc.2025.101059. eCollection 2025 Sep.
The impact of the association of LDL-c levels with coronary heart disease is unambiguous in people with previous cardiovascular disease. In primary prevention, however, it has been poorly studied. We analyzed the impact of the association of lipid levels with coronary heart disease in a population with no previous cardiovascular disease. We included potential variations by sex and age.
Retrospective cohort analysis of records from the SIDIAP Catalan database, Spain. We selected ≥35-year-olds without previous cardiovascular disease or lipid-lowering medications. The LDL, HDL, and triglycerides levels were the exposure and coronary heart disease was the outcome. Cox regression and Lin additive models estimated the relative and absolute associations, respectively.
We analyzed the records from 730,236 participants; follow-up: 6.7 years; mean (SD) age: 58.5 (13.9) years, and 42.2 % of them were men. The overall CHD incidence rate was 3.47 (3.42-3.52) events per 1000 person-years; it was higher in men than in women, with 4.98 (4.88-5.07) and 2.39 (2.33-2.45) events per 1000 person-years, respectively. One mmol/L increase in LDL-c, HDL-c, and TGs showed HRs (95 %CI) of 1.26 (1.24-1.29), 0.60 (0.57-0.63), and 1.16 (1.13-1.19), respectively. The absolute differences for LDL-c and TGs were less than one additional CHD event per 1000 person-years; and two fewer events for HDL-c.
The moderate to low increment in the incidence of CHD by 1 mmol/L of lipid increase represented low numbers of additional events in this low-risk Mediterranean population.
低密度脂蛋白胆固醇（LDL-c）水平与冠心病之间的关联，在既往有心血管疾病的人群中已明确。然而，在一级预防中，相关研究较少。我们分析了在无心血管疾病病史人群中，血脂水平与冠心病之间关联的影响，并纳入了性别和年龄的潜在差异。
对西班牙SIDIAP加泰罗尼亚数据库中的记录进行回顾性队列分析。我们选取了年龄≥35岁、无心血管疾病病史或降脂药物治疗史的人群。LDL、HDL和甘油三酯水平作为暴露因素，冠心病作为结局。Cox回归模型和线性相加模型分别估计相对关联和绝对关联。
我们分析了730236名参与者的记录；随访时间为6.7年；平均（标准差）年龄为58.5（13.9）岁，其中42.2%为男性。冠心病总体发病率为每1000人年3.47（3.42 - 3.52）例；男性高于女性，分别为每1000人年4.98（4.88 - 5.07）例和2.39（2.33 - 2.45）例。LDL-c、HDL-c和甘油三酯每增加1 mmol/L，风险比（95%置信区间）分别为1.26（1.24 - 1.29）、0.60（0.57 - 0.63）和1.16（1.13 - 1.19）。LDL-c和甘油三酯每1000人年新增冠心病事件的绝对差异小于1例；HDL-c每1000人年减少2例。
在这个低风险的地中海人群中，血脂每升高1 mmol/L，冠心病发病率适度至低度增加所导致的新增事件数量较少。
