Kinosian B, Glick H, Preiss L, Puder K L
University of Pennsylvania, Philadelphia 19104, USA.
J Investig Med. 1995 Oct;43(5):443-50.
Little is known about the relative ability of different measures of change in cholesterol to discriminate coronary heart disease risk. We evaluated this ability for changes in low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, LDL/HDL ratios, and total cholesterol/HDL ratios.
We predicted risks of coronary heart disease using data from 3641 men in the Lipid Research Clinics Coronary Primary Prevention Trial. Treating these patients as a cohort, we estimated risks associated with changes in cholesterol levels independent of the patients' randomization group.
Changes in LDL and HDL cholesterol when used in combination were each significant predictors of coronary heart disease risk (odds ratios [OR] for 10% increases, 1.15 and 0.84, respectively; P < 0.001). Changes in LDL/HDL and total cholesterol/HDL ratios had similar discriminating ability (OR for 10% increases, 1.17 and 1.21, respectively; P < 0.0001). In the best discriminating models, changes in ratios added information about risks to changes in LDL cholesterol, although changes in LDL cholesterol levels failed to add information to changes in ratios.
Changes in total cholesterol/HDL and LDL/HDL ratios were better predictors of risk for coronary heart disease than were changes in LDL cholesterol levels alone. When assessed as percentage changes averaged during the first two months of intervention, they were among the best discriminators of risk. Clinicians selecting treatments for intervention should include among their considerations the treatment's effect on both LDL and HDL cholesterol rather than their effects on LDL cholesterol levels alone.
关于胆固醇变化的不同测量指标区分冠心病风险的相对能力，人们了解甚少。我们评估了低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、LDL/HDL比值和总胆固醇/HDL比值变化的这种能力。
我们使用脂质研究临床冠心病一级预防试验中3641名男性的数据预测冠心病风险。将这些患者视为一个队列，我们估计了与胆固醇水平变化相关的风险，而不考虑患者的随机分组。
LDL和HDL胆固醇变化联合使用时，均是冠心病风险的显著预测指标（10%升高的比值比[OR]分别为1.15和0.84；P<0.001）。LDL/HDL和总胆固醇/HDL比值变化具有相似的区分能力（10%升高的OR分别为1.17和1.21；P<0.0001）。在最佳区分模型中，比值变化为LDL胆固醇变化的风险信息增添了内容，尽管LDL胆固醇水平变化未能为比值变化增添信息。
总胆固醇/HDL和LDL/HDL比值变化比单独的LDL胆固醇水平变化更能预测冠心病风险。当作为干预前两个月的平均百分比变化进行评估时，它们是风险的最佳区分指标之一。选择干预治疗的临床医生应将治疗对LDL和HDL胆固醇的影响而非仅对LDL胆固醇水平的影响纳入考虑。
