Hypertriglyceridaemia and cardiovascular mortality: insights from a large-scale study.
Hypertriglyceridaemia and cardiovascular mortality: insights from a large-scale study.
复制标题
高甘油三酯血症和心血管死亡率：来自大规模研究的见解。
DOI：
10.1093/eurjpc/zwad391
复制
发表时间：
2024
影响因子：
8.3
通讯作者：
Martin,SethS
中科院分区：
文献类型：
--
作者：
Patel,Hamza;Grant,JelaniK;Martin,SethS
高胆固醇血症（HTG）是临床实践中常见的，发生在15-20%的成年人群中。[1]越来越多的证据表明，富含磷脂酰肌醇的残余脂蛋白在动脉粥样硬化性心血管疾病（ASCVD）中起着因果作用，它们作为潜在药物靶点的作用仍然是一个活跃的研究领域。2，3据认为，驱动HTG和ASCVD之间的风险关联的是残余脂蛋白颗粒的胆固醇含量和相关的促炎状态。4然而，在之前的研究中，在调整主要风险因素（例如低密度脂蛋白胆固醇（LDL-C）水平和高密度脂蛋白胆固醇（HDL-C））后，HTG与ASCVD之间的关联被大幅削弱。5同时，降低LDL-C的手段已经扩大，许多有ASCVD风险的患者可以达到低LDL-C水平。因此，出现了两个主要问题：（i）HTG和心血管风险之间的关联是否在不同的LDL-C水平下持续存在，以及（ii）这种关联是否最好使用大型数据集进行研究，具有非常大的样本量，在广泛的LDL-C值范围内？Park博士、Yi博士及其同事发表的题为《根据1560万人口中的低密度脂蛋白胆固醇，高脂血症对心血管死亡率的影响》的论文深入研究了韩国人群中甘油三酯（TG）水平与心血管疾病（CVD）死亡率之间的关系。6这项研究的一个明显优势是它的规模。这些数据是从韩国国家健康保险服务推断出来的，覆盖了97%的强制性健康保险人口，包括18-99岁的个人两年一次的健康筛查。大型数据集能够对各种LDL-C水平以及年龄，性别和其他因素进行分层。这项研究调查了总体CVD死亡率和与缺血性心脏病、急性心肌梗死、缺血性、出血性卒中和心力衰竭相关的死亡率，这项研究的结果对围绕HTG及其作为独立CVD危险因素的作用的持续争论做出了重大贡献。该研究报告了TG水平和总体CVD死亡率之间的对数线性关系，特别是缺血性心脏病和急性心肌梗死。这种关联在TG水平的范围内都成立，
Hypertriglyceridaemia (HTG) is commonly encountered in clinical practice, occurring in 15–20% of the adult population. 1 Accumulating evidence points to triglyceride-rich remnant lipoproteins as playing a causal role in atherosclerotic cardiovascular disease (ASCVD), and their role as a potential drug target remains an active area of investigation. 2, 3 It is thought that what drives the risk association between HTG and ASCVD is the cholesterol content of remnant lipoprotein particles and an associated pro-inflammatory state. 4 However, in prior studies, the association between HTG and ASCVD was substantially weakened after adjustment for major risk factors, such as low-density lipoprotein cholesterol (LDL-C) level and high-density lipoprotein cholesterol (HDL-C). 5 Meanwhile, the armamentarium to lower LDL-C has expanded such that many patients at risk for ASCVD can achieve low LDL-C levels. As such, two main questions arise:(i) does the association between HTG and cardiovascular risk persist across varying LDL-C levels and (ii) is this association best investigated using a large dataset, with a very large sample size, across a wide range of LDL-C values? The paper titled ‘Impact of hypertriglyceridaemia on cardiovascular mortality according to low-density lipoprotein cholesterol in a 15.6 million population’by Dr. Park, Dr. Yi, and colleagues dives into the association between triglyceride (TG) levels and cardiovascular disease (CVD) mortality in a South Korean population. 6 An obvious strength of this study is its size. The data were extrapolated from the National Health Insurance Service in South Korea, covering 97% of the population with obligatory health insurance inclusive of biennial health screenings in individuals aged 18–99 years. The large dataset enabled the ability to stratify across various LDL-C levels, as well as by age, sex, and other factors. The study examines overall CVD mortality and mortality related to ischaemic heart disease, acute myocardial infarction, ischaemic, haemorrhagic stroke, and heart failure.The findings of this study contribute significantly to the ongoing debate surrounding HTG and its role as an independent CVD risk factor. The study reports a log-linear relationship between TG levels and overall CVD mortality, particularly ischaemic heart disease and acute myocardial infarction. This association holds across the range of TG levels,