Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium
Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium
复制标题
DOI：
10.1016/s0140-6736(19)32519-x
复制
发表时间：
2019-12-14
期刊：
影响因子：
168.9
通讯作者：
Ikram, M. K.
中科院分区：
文献类型：
--
作者：
Brunner, Fabian J.;Waldeyer, Christoph;Ikram, M. K.
血脂浓度与心血管疾病长期发病率的相关性以及降脂治疗与心血管疾病结局的相关性尚不清楚。我们研究了与全谱血流非HDL胆固醇浓度相关的心血管疾病风险。我们还创建了一个易于使用的工具，以估计长期的概率与非HDL胆固醇的心血管疾病事件，并模拟其风险降低降脂treatment.Methods在这个风险评估和风险建模研究，我们使用多国心血管风险联盟的数据来自欧洲，澳大利亚和北美的19个国家。纳入了基线时无心血管疾病且有可靠的心血管疾病结局数据的个体。动脉粥样硬化性心血管疾病的主要复合终点定义为冠心病事件或缺血性卒中的发生。根据欧洲指南阈值，使用非HDL胆固醇类别计算性别特异性多变量分析，调整年龄，性别，队列和经典的可改变的心血管风险因素。在推导和验证设计中，我们创建了一个工具来估计75岁时发生心血管疾病事件的概率，取决于年龄，性别和风险因素，以及相关的建模风险降低，假设非HDL胆固醇降低50%。我们确定了398846名个体，属于38个队列（184055名[48.7%]女性;中位年龄51.0岁[IQR 40.7-59.7]）。199415人被纳入推导队列（91786 [48.4%]女性），199431人（92269 [49.1%]女性）被纳入验证队列。在最长43.6年的随访期间（中位数13.5年，IQR 7.0-20.1），发生了54542例心血管终点。发病率曲线分析显示，随着非HDL胆固醇类别的增加，30年心血管疾病事件发生率逐渐升高（女性非HDL胆固醇= 5.7 mmol/L为7.7%，男性为12.8%至43.6%; p
Background The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment.Methods In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol.Findings Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48.7%] women; median age 51.0 years [IQR 40.7-59.7]). 199 415 individuals were included in the derivation cohort (91 786 [48.4%] women) and 199 431 (92 269 [49.1%] women) in the validation cohort. During a maximum follow-up of 43.6 years (median 13.5 years, IQR 7.0-20.1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease eventrates for increasing non-HDL cholesterol categories (from 7.7% for non-HDL cholesterol = 5.7 mmol/L in women and from 12.8% to 43.6% in men; p