Criqui M H, Heiss G, Cohn R, Cowan L D, Suchindran C M, Bangdiwala S, Kritchevsky S, Jacobs D R, O'Grady H K, Davis C E
Department of Community and Family Medicine, University of California, La Jolla.
N Engl J Med. 1993 Apr 29;328(17):1220-5. doi: 10.1056/NEJM199304293281702.
Whether the plasma triglyceride level is a risk factor for coronary heart disease has been controversial, and evaluation of the triglyceride level as a risk factor is fraught with methodologic difficulties.
We studied the association between plasma triglyceride levels and the 12-year incidence of death from coronary heart disease in 10 North American populations participating in the Lipid Research Clinics Follow-up Study, while adjusting for the potential confounding effects of other risk factors for cardiovascular disease, including the level of high-density lipoprotein (HDL) cholesterol. All analyses were sex-specific, and separate analyses were performed in high and low strata of HDL cholesterol, low-density lipoprotein (LDL) cholesterol, fasting plasma glucose, and age.
The rates of coronary death in both men and women increased with the triglyceride level. In Cox proportional-hazards models adjusted for age, in which the natural log of the triglyceride levels was used to give a normal distribution, the relative risk per natural-log unit of triglyceride (e.g., a triglyceride level of 150 mg per deciliter vs. a level of 55 mg per deciliter) was 1.54 (95 percent confidence interval, 1.19 to 1.98; P < 0.001) in men and 1.88 (95 percent confidence interval, 1.19 to 2.98; P < 0.007) in women. After an adjustment for potential covariates, however, these relative risks were not statistically significant. Analyses based on lipoprotein cholesterol levels revealed a positive association between the triglyceride level and coronary mortality in the lower stratum of both HDL and LDL cholesterol, but not in the higher stratum. Conversely, the HDL cholesterol level was unrelated to coronary mortality in the lower stratum of LDL cholesterol, but was strongly inversely associated with coronary death in the higher stratum of LDL cholesterol. The relative risk of coronary death associated with triglyceride level was higher at younger ages. The associations between the triglyceride level and coronary mortality in the lower HDL cholesterol, LDL cholesterol, and age strata were small and were further reduced by an adjustment for the fasting plasma glucose level.
Overall, the plasma triglyceride level showed no independent association with coronary mortality. However, in subgroups of subjects with lower HDL and LDL cholesterol levels and in younger subjects, defined a priori, an association between the triglyceride level and coronary mortality was observed, although this association was small and was not statistically significant after an adjustment for the plasma glucose level.
血浆甘油三酯水平是否为冠心病的危险因素一直存在争议，将甘油三酯水平作为危险因素进行评估存在诸多方法学上的困难。
我们在参与脂质研究临床随访研究的10个北美人群中，研究了血浆甘油三酯水平与冠心病12年死亡发生率之间的关联，同时对心血管疾病其他危险因素（包括高密度脂蛋白（HDL）胆固醇水平）的潜在混杂效应进行了校正。所有分析均按性别进行，并且在HDL胆固醇、低密度脂蛋白（LDL）胆固醇、空腹血糖和年龄的高低分层中分别进行分析。
男性和女性的冠心病死亡率均随甘油三酯水平升高而增加。在经年龄校正的Cox比例风险模型中，使用甘油三酯水平的自然对数以使其呈正态分布，甘油三酯每自然对数单位的相对风险（例如，甘油三酯水平为150mg/dL与55mg/dL相比）在男性中为1.54（95%置信区间为1.19至1.98；P<0.001），在女性中为1.88（95%置信区间为1.19至2.98；P<0.007）。然而，在对潜在协变量进行校正后，这些相对风险无统计学意义。基于脂蛋白胆固醇水平的分析显示，在HDL和LDL胆固醇水平较低的分层中，甘油三酯水平与冠心病死亡率呈正相关，但在较高分层中并非如此。相反，HDL胆固醇水平在LDL胆固醇水平较低的分层中与冠心病死亡率无关，但在LDL胆固醇水平较高的分层中与冠心病死亡呈强烈负相关。与甘油三酯水平相关的冠心病死亡相对风险在较年轻年龄段更高。在HDL胆固醇、LDL胆固醇和年龄较低分层中，甘油三酯水平与冠心病死亡率之间的关联较小，且在对空腹血糖水平进行校正后进一步降低。
总体而言，血浆甘油三酯水平与冠心病死亡率无独立关联。然而，在预先定义的HDL和LDL胆固醇水平较低的亚组以及较年轻的受试者中，观察到甘油三酯水平与冠心病死亡率之间存在关联，尽管这种关联较小，且在对血浆葡萄糖水平进行校正后无统计学意义。
