Cholesterol measures to identify and treat individuals at risk for coronary heart disease
Cholesterol measures to identify and treat individuals at risk for coronary heart disease
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DOI：
10.1016/s0749-3797(03)00092-8
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发表时间：
2003-07-01
影响因子：
5.5
通讯作者：
Kinosian, B
中科院分区：
文献类型：
--
作者：
Natarajan, S;Glick, H;Kinosian, B
背景资料：低密度脂蛋白（LDL）为基础的指南目前用于启动和监测降胆固醇治疗。使用分层分析，对来自心脏病研究和冠状动脉一级预防试验的数据进行评估，以确定（1）胆固醇水平（总胆固醇[TC]或低密度脂蛋白[LDL]）是否比胆固醇比率更能区分冠心病（CHD）的风险（2）LDL/HDL [高密度脂蛋白]或TC/HDL的比值变化是否比水平变化更能预测风险降低。LDL/HDL比值相似的个体患冠心病的风险相似，无论他们是LDL水平高还是LDL水平低（CPPT为23%对23%，FHS男性为13.8%对14%，FHS女性为8.6%对10.9%）。在LDL/HDL比值和LDL/HDL比值变化相似的男性中，LDL水平下降最大和最小的人群（21.3%比6.5%）患冠心病的风险没有差异（20.3%比21.0%; p =0.96）。在具有相似的初始LDL水平和相似的LDL降低的男性中，在LDL/HDL比率降低最大和最小的人（23%比4.6%）之间，冠心病风险降低20%（19.5%比24.5%; p =0.005）。TC/HDL的预测能力与LDL/HDL.Conclusions相似：胆固醇水平并不能提供比胆固醇比率更高的预测价值，以确定冠心病的危险人群。比值的变化比水平的变化更能预测成功降低CHD风险。未来的指南应考虑在启动和监测成功的降脂治疗中纳入比值。
Background: Low-density lipoprotein (LDL)-based guidelines are currently used to initiate and monitor cholesterol-lowering therapy.Methods: Using stratified analyses, data from the Framingham Heart Study and the Coronary Primary Prevention Trial were evaluated to determine whether (1) cholesterol levels total cholesterol [TC] or LDL [low-density lipoprotein]) better discriminated risk for coronary heart disease (CHD) than cholesterol ratios (LDL/HDL [high-density lipoprotein] or TC/HDL); and (2) whether changes in ratios better predicted risk reduction than changes in levels.Results: Individuals with similar LDL/HDL ratios had similar risks for CHD regardless of whether they had high LDL levels or low LDL levels (23% vs 23% for the CPPT, 13.8% vs 14% for FHS men, and 8.6% vs 10.9% for FHS women). Among men with similar initial LDL/HDL ratios and similar changes in LDL/HDL ratios, risks for CHD did not differ (20.3% compared with 21.0%; p =0.96) between those with the largest and smallest reductions in LDL levels (21.3% compared with 6.5%). Among men with similar initial LDL levels and similar LDL reductions, a 20% reduction in risk for CHD was seen (19.5% compared with 24.5%; p =0.005) between those with the largest and smallest reductions in LDL/HDL ratios (23% compared with 4.6%). TC/HDL had predictive ability similar to LDL/HDL.Conclusions: Cholesterol levels do not provide incremental predictive value over cholesterol ratios in identifying people at risk for CHD. Changes in ratios are better predictors of successful CHD risk reduction than changes in levels. Future guidelines should consider incorporating ratios in initiating and monitoring successful lipid-lowering therapy.