儿童低密度脂蛋白胆固醇水平在预测成人血脂异常及其他心血管风险中的作用。博加卢萨心脏研究。

Usefulness of childhood low-density lipoprotein cholesterol level in predicting adult dyslipidemia and other cardiovascular risks. The Bogalusa Heart Study.

作者信息

Bao W, Srinivasan S R, Wattigney W A, Bao W, Berenson G S

机构信息

Tulane National Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, La., USA.

出版信息

Arch Intern Med. 1996 Jun 24;156(12):1315-20.

PMID:8651840

Abstract

OBJECTIVE

To examine the usefulness of childhood low-density lipoprotein cholesterol (LDL-C) measurement for predicting future dyslipidemia and other cardiovascular risk in adulthood.

METHODS

A longitudinal cohort over 15 years was identified from a community study of the natural course of arteriosclerosis: 1169 individuals (34% black), aged 5 to 14 years, were included at initial study.

RESULTS

Levels of lipoprotein variables in childhood were associated with levels in adulthood, more strongly for total cholesterol (r = .4-.6) and LDL-C (r = .4-.6) than for high-density lipoprotein cholesterol (r = .2-.4) and triglycerides (r = .1-.4). In a stepwise multiple regression, the childhood level was most predictive of the adulthood level, followed by change in body mass index (weight in kilograms/height in meters squared) from childhood to adulthood, with explained variability (R2) of .29, .30, .27, and .19 for total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglycerides, respectively. Adulthood dyslipidemia, as defined by the National Cholesterol Education Program criterion, was best predicted by childhood LDL-C level among other lipoprotein variables. Compared with subjects with acceptable childhood risk (LDL-C level, < 2.84 mmol/L [< 110 md/dL]), those (6%) with high childhood risk (LDL-C level, > or = 3.36 mmol/L [> or = 130 mg/dL]) not only had a higher prevalence of dyslipidemic total cholesterol level (24%, 8.3-fold), LDL-C level (28%, 5.4-fold), triglyceride level (7%, sevenfold) and lower HDL-C level (14%, 2.1-fold), but also had a significantly higher (P < .05) prevalence of obesity (43%, 1.6-fold) and hypertension (19%, 2.4-fold). In addition, if the childhood LDL-C elevation (> 90th percentile) was persistent, the prevalence of adult dyslipidemia would be markedly increased (P < .001).

CONCLUSIONS

Adverse levels of LDL-C in childhood persist over time, progress to adult dyslipidemia, and relate to obesity and hypertension as well. National Cholesterol Education Program guidelines to classify cardiovascular risk on the basis of LDL-C level are helpful in targeting individuals at risk early in life.

摘要

目的

探讨儿童低密度脂蛋白胆固醇（LDL-C）测量对于预测成年期未来血脂异常及其他心血管风险的有用性。

方法

从一项关于动脉硬化自然病程的社区研究中确定了一个为期15年的纵向队列：初始研究纳入了1169名5至14岁的个体（34%为黑人）。

结果

儿童期脂蛋白变量水平与成年期水平相关，总胆固醇（r = 0.4 - 0.6）和LDL-C（r = 0.4 - 0.6）的相关性比高密度脂蛋白胆固醇（r = 0.2 - 0.4）和甘油三酯（r = 0.1 - 0.4）更强。在逐步多元回归中，儿童期水平对成年期水平的预测性最强，其次是从儿童期到成年期体重指数（体重千克数/身高米数的平方）的变化，总胆固醇、LDL-C、高密度脂蛋白胆固醇和甘油三酯的解释变异度（R2）分别为0.29、0.30、0.27和0.19。根据国家胆固醇教育计划标准定义的成年期血脂异常，在其他脂蛋白变量中，儿童期LDL-C水平的预测性最佳。与儿童期风险可接受（LDL-C水平，< 2.84 mmol/L [< 110 mg/dL]）的受试者相比，儿童期风险高（LDL-C水平，≥ 3.36 mmol/L [≥ 130 mg/dL]）的受试者（6%）不仅血脂异常的总胆固醇水平患病率更高（24%，8.3倍）、LDL-C水平患病率更高（28%，5.4倍）、甘油三酯水平患病率更高（7%，7倍）且高密度脂蛋白胆固醇水平更低（14%，2.1倍），而且肥胖（43%，1.6倍）和高血压（19%，2.4倍）的患病率也显著更高（P < 0.05）。此外，如果儿童期LDL-C升高（>第90百分位数）持续存在，成年期血脂异常的患病率将显著增加（P < 0.001）。