Relation of Clinical Benefit of Raising High-Density Lipoprotein Cholesterol to Serum Levels of Low-Density Lipoprotein Cholesterol in Patients With Coronary Heart Disease (from the Bezafibrate Infarction Prevention Trial)
Relation of Clinical Benefit of Raising High-Density Lipoprotein Cholesterol to Serum Levels of Low-Density Lipoprotein Cholesterol in Patients With Coronary Heart Disease (from the Bezafibrate Infarction Prevention Trial)
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DOI：
10.1016/j.amjcard.2008.08.033
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发表时间：
2009-01-01
影响因子：
2.8
通讯作者：
Behar, Shlomo
中科院分区：
文献类型：
--
作者：
Goldenberg, Ilan;Benderly, Michal;Behar, Shlomo
低高密度脂蛋白（HDL）胆固醇是心血管风险的一个强有力的独立预测因子。本研究旨在评估冠心病（CAD）患者对HDL胆固醇修饰的临床反应与血清低密度脂蛋白（LDL）胆固醇水平之间的关系。3,020例参加苯扎贝特预防心肌梗死（BIP）试验的CAD患者在中位7.9年随访期间发生主要心脏事件（定义为非致死性心肌梗死或心源性死亡）的风险与研究期间血脂水平的变化有关。根据国家胆固醇教育计划成人治疗组III标准对基线LDL胆固醇水平进行分类。多变量分析表明，HDL胆固醇升高的获益在基线LDL胆固醇较低的患者中最为明显（≥ 160 mg/dl;风险比0.94，95%置信区间0.75 - 1.17，p = 0.14）。风险降低相关的甘油三酯降低也显示出类似的关系，而基线LDL胆固醇>= 130 mg/dl的患者中LDL胆固醇降低的益处更明显。总之，这些数据表明，对HDL胆固醇和甘油三酯修饰的临床反应与基线LDL胆固醇水平呈负相关。因此，对基线和随访血脂水平进行联合评估，以指导CAD患者的治疗目标，可为仅基于LDL胆固醇修饰的二级预防提供增量预后信息。(C)2009 Elsevier Inc. (Am J Cardiol 2009;103：41-45）
Low high-density lipoprotein (HDL) cholesterol is a strong independent predictor of cardiovascular risk. The present study was designed to assess the relation between the clinical response to HDL cholesterol modification and serum levels of low-density lipoprotein (LDL) cholesterol in patients with coronary artery disease (CAD). The risk for a major cardiac event (defined as nonfatal myocardial infarction or cardiac death) during a median 7.9-year follow-up period in 3,020 patients with CAD enrolled in the Bezafibrate Infarction Prevention (BIP) trial was related to changes in lipid levels during the study. Baseline LDL cholesterol levels were categorized according to National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate analysis demonstrated that the benefit of HDL cholesterol increase was most pronounced in patients with low baseline LDL cholesterol (= 160 mg/dl; hazard ratio 0.94, 95% confidence interval 0.75 to 1.17, p = 0.14). A similar relation was shown for risk reduction-associated triglyceride decrements, whereas the benefit of LDL cholesterol reduction was more pronounced in patients with baseline LDL cholesterol >= 130 mg/dl. In conclusion, these data suggest that the clinical response to HDL cholesterol and triglyceride modification is inversely related to baseline LDL cholesterol levels. Thus, combined assessment of baseline and follow-up lipid levels to direct therapeutic goals in patients with CAD may provide incremental prognostic information to secondary prevention that is based solely on LDL cholesterol modification. (C) 2009 Elsevier Inc. (Am J Cardiol 2009;103:41-45)