Bass K M, Newschaffer C J, Klag M J, Bush T L
Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD.
Arch Intern Med. 1993 Oct 11;153(19):2209-16.
The association of lipoprotein levels with cardiovascular disease (CVD) is less well understood in women than in men. To better characterize any relationships, associations between CVD death and total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol and triglyceride levels in women were explored using data from female participants in the Lipid Research Clinics' Follow-up Study.
Using a sample of 1405 women aged 50 to 69 years from the Lipid Research Clinics' Follow-up Study, age-adjusted CVD death rates and summary relative risk (RR) estimates by categories of lipid and lipoprotein levels were calculated. Multivariate analysis was performed to provide RR estimates adjusted for other CVD risk factors.
Average follow-up was 14 years. High-density lipoprotein and triglyceride levels were strong predictors of CVD death in age-adjusted and multivariate analyses. Low-density lipoprotein and total cholesterol levels were poorer predictors of CVD mortality. After adjustment for other CVD risk factors, HDL levels less than 1.30 mmol/L (50 mg/dL) were strongly associated with cardiovascular mortality (RR = 1.74; 95% confidence interval [CI], 1.10 to 2.75). Triglyceride levels were associated with increased CVD mortality at levels of 2.25 to 4.49 mmol/L (200 to 399 mg/dL) (RR = 1.65; 95% CI, 0.99 to 2.77) and 4.50 mmol/L (400 mg/dL) or greater (RR = 3.44; 95% CI, 1.65 to 7.20). At total cholesterol levels of 5.20 mmol/L (200 mg/dL) or greater and at all levels of LDL and triglycerides, women with HDL levels of less than 1.30 mmol/L (< 50 mg/dL) had CVD death rates that were higher than those of women with HDL levels of 1.30 mmol/L (50 mg/dL) or greater.
High-density lipoprotein and triglyceride levels are independent lipid predictors of CVD death in women. Cholesterol screening guidelines should be re-evaluated to reflect the importance of HDL and triglyceride levels in determining CVD risk in women.
与男性相比，脂蛋白水平与心血管疾病（CVD）之间的关联在女性中了解较少。为了更好地描述其间的关系，我们利用脂质研究诊所随访研究中女性参与者的数据，探讨了女性CVD死亡与总胆固醇、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）胆固醇以及甘油三酯水平之间的关联。
采用脂质研究诊所随访研究中1405名年龄在50至69岁之间的女性样本，计算经年龄调整的CVD死亡率以及按脂质和脂蛋白水平类别划分的汇总相对风险（RR）估计值。进行多变量分析以提供针对其他CVD危险因素调整后的RR估计值。
平均随访时间为14年。在年龄调整分析和多变量分析中，高密度脂蛋白和甘油三酯水平是CVD死亡的有力预测指标。低密度脂蛋白和总胆固醇水平对CVD死亡率的预测能力较差。在调整其他CVD危险因素后，HDL水平低于1.30 mmol/L（50 mg/dL）与心血管死亡率密切相关（RR = 1.74；95%置信区间[CI]，1.10至2.75）。甘油三酯水平在2.25至4.49 mmol/L（200至399 mg/dL）（RR = 1.65；95% CI，0.99至2.77）以及4.50 mmol/L（400 mg/dL）及以上时与CVD死亡率增加相关（RR = 3.44；95% CI，1.65至7.20）。在总胆固醇水平为5.20 mmol/L（200 mg/dL）及以上以及LDL和甘油三酯的所有水平上，HDL水平低于1.30 mmol/L（< 50 mg/dL）的女性CVD死亡率高于HDL水平为1.30 mmol/L（50 mg/dL）及以上的女性。
高密度脂蛋白和甘油三酯水平是女性CVD死亡的独立脂质预测指标。应重新评估胆固醇筛查指南，以反映HDL和甘油三酯水平在确定女性CVD风险中的重要性。
