Clinical utility of different lipid measures for prediction of coronary heart disease in men and women
Clinical utility of different lipid measures for prediction of coronary heart disease in men and women
复制标题
DOI：
10.1001/jama.298.7.776
复制
发表时间：
2007-08-15
影响因子：
120.7
通讯作者：
Vasan, Ramachandran S.
中科院分区：
文献类型：
--
作者：
Ingelsson, Erik;Schaefer, Ernst J.;Vasan, Ramachandran S.
关于载脂蛋白与传统脂质在预测冠心病（CHD）风险方面的表现，证据是相互矛盾的。目的比较不同血脂指标在冠心病预测中的应用，包括区分、校准特征和危险类别的重新分类；评估载脂蛋白相对于传统脂质在冠心病预测中的增量效用。设计、环境和参与者基于人群的前瞻性队列，来自马萨诸塞州弗雷明汉。我们评估了3322名参加第四个子代检查周期（1987-1991）且无心血管疾病的中年白人受试者的血清总胆固醇、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、非HDL-C、载脂蛋白（apo） A-I和载脂蛋白B，以及3种脂质比率（总胆固醇：HDL-C、LDL-C: HDL-C和载脂蛋白B：载脂蛋白A-I）。53%的参与者是女性。首次冠心病事件的发生率（可识别或未识别的心肌梗死、心绞痛、冠状动脉功能不全或冠心病死亡）。结果中位随访15.0年后，291名参与者（其中198名是男性）患上了冠心病。nonlipid风险因素在多变量模型调整,apo B: apo -ⅰ比率预测冠心病(危险比[HR] / SD增量,1.39;95%可信区间(CI), 1.23 - -1.58在男人和人力资源,1.40;95%可信区间,1.16 - -1.67)的女性,但总胆固醇的风险比率相似:高密度脂蛋白胆固醇(HR 1.39; 95%可信区间,1.22 - -1.58在男人和人力资源,1.39;95%可信区间,1.17 - -1.66在女性)和支持:高密度脂蛋白胆固醇(HR 1.35; 95%可信区间,1.18 - -1.54在男人和人力资源,1.36;95%可信区间1.14 - -1.63)的女性。在两性中，使用载脂蛋白B：载脂蛋白A-I比例的模型表现出与其他脂质比例相当但不优于其他比例的模型的性能特征。在包含Framingham风险评分的所有组成部分（包括总胆固醇：HDL-C）的模型中，载脂蛋白B：载脂蛋白a - i比率不能预测冠心病风险（男性P = 0.12，女性P = 0.58）。在这个基于人群的大型队列中，载脂蛋白B：载脂蛋白A-I比值预测冠心病的总体表现与传统的脂质比值相当，但与总胆固醇：HDL-C相比没有提供增量效用。当总胆固醇和HDL-C测量可用时，这些数据不支持在临床实践中测量载脂蛋白B或载脂蛋白A-I。
Context Evidence is conflicting regarding the performance of apolipoproteins vs traditional lipids for predicting coronary heart disease (CHD) risk.Objectives To compare performance of different lipid measures for CHD prediction using discrimination and calibration characteristics and reclassification of risk categories; to assess incremental utility of apolipoproteins over traditional lipids for CHD prediction.Design, Setting, and Participants Population-based, prospective cohort from, Framingham, Massachusetts. We evaluated serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non HDL-C, apolipoprotein (apo) A-I and apo B, and 3 lipid ratios ( total cholesterol: HDL-C, LDL-C: HDL-C, and apo B: apo A-I) in 3322 middle-aged white participants who attended the fourth offspring examination cycle (1987-1991) and were without cardiovascular disease. Fifty-three percent of the participants were women.Main Outcome Measure Incidence of first CHD event (recognized or unrecognized myocardial infarction, angina pectoris, coronary insufficiency, or coronary heart disease death).Results After a median follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD. In multivariate models adjusting for nonlipid risk factors, the apo B: apo A-I ratio predicted CHD (hazard ratio [HR] per SD increment, 1.39; 95% confidence interval [CI], 1.23-1.58 in men and HR, 1.40; 95% CI, 1.16-1.67 in women), but risk ratios were similar for total cholesterol: HDL-C (HR, 1.39; 95% CI, 1.22-1.58 in men and HR, 1.39; 95% CI, 1.17-1.66 in women) and for LDL-C: HDL-C (HR, 1.35; 95% CI, 1.18-1.54 in men and HR, 1.36; 95% CI 1.14-1.63 in women). In both sexes, models using the apo B: apo A-I ratio demonstrated performance characteristics comparable with but not better than that for other lipid ratios. The apo B: apo A-I ratio did not predict CHD risk in a model containing all components of the Framingham risk score including total cholesterol: HDL-C (P = .12 in men; P = .58 in women).Conclusions In this large, population-based cohort, the overall performance of apo B: apo A-I ratio for prediction of CHD was comparable with that of traditional lipid ratios but did not offer incremental utility over total cholesterol: HDL-C. These data do not support measurement of apo B or apo A-I in clinical practice when total cholesterol and HDL-C measurements are available.