High-density lipoprotein cholesterol in diabetes: Is higher always better?
High-density lipoprotein cholesterol in diabetes: Is higher always better?
复制标题
DOI：
10.1016/j.jacl.2011.06.011
复制
发表时间：
2011-10-01
影响因子：
4.4
通讯作者：
Orchard, Trevor J.
中科院分区：
文献类型：
--
作者：
Costacou, Tina;Evans, Rhobert W.;Orchard, Trevor J.
背景：最近的数据表明，高密度脂蛋白胆固醇(高密度脂蛋白-C)的高度升高可能并不总是预防心血管疾病。虽然尽管平均高密度脂蛋白胆固醇升高，但心血管风险增加，但在1型糖尿病中，这种情况在多大程度上是未知的。目的：重新评估儿童起病的1型糖尿病患者中高密度脂蛋白胆固醇及其减数与冠状动脉疾病(CAD)的关系。方法：糖尿病并发症流行病学研究研究对象为基线无冠心病的受试者(男性301人，女性298人；平均年龄27.1岁，糖尿病病程18.9年)。冠心病的定义为心绞痛、缺血性心电图改变、确诊的心肌梗死、血管造影狭窄=50%、血运重建或冠心病死亡。结果：在18年的随访期内，29.5%的男性和25.5%的女性发生了冠心病。虽然男性的发病率随着高密度脂蛋白胆固醇浓度的增加呈线性下降，但女性的发病率在低于47 mg/dL和大于80 mg/dL时增加。这些模式在很大程度上反映了HDL3胆固醇与CAD的关系。在多变量调整后，男性保持线性、反向的高密度脂蛋白胆固醇/冠心病关联(危险比[HR]0.97，95%可信区间[CI]0.94-0.99)；在女性中，U型关系失去意义。在男性(线性关联，P=0.03)和女性(最低和最高的HR分别为2.31(95%CI 1.31-4.08)和HR 1.80(95%CI 1.01-3.23))中，HDL3胆固醇与冠心病的关系仍然是多变量的。结论：女性在1型糖尿病中高密度脂蛋白胆固醇水平为80 mg/dL的冠心病风险增加值得进一步研究。性别特异性无法确定，因为只有两名男性的高密度脂蛋白胆固醇水平为80 mg/dl。(C)2011年全国油脂协会。版权所有。
BACKGROUND: Recent data suggest that highly elevated high-density lipoprotein cholesterol (HDL-C) may not always protect against cardiovascular disease. To what degree this is true in type 1 diabetes is unknown, although cardiovascular risk is increased despite elevated mean HDL-C.OBJECTIVE: To reassess the association between HDL-C and its subtractions with coronary artery disease (CAD) in childhood-onset type 1 diabetes.METHODS: Epidemiology of Diabetes Complications study participants free of CAD at baseline (301 men, 298 women; mean age, 27.1 and diabetes duration, 18.9 years) were studied. CAD was defined as angina, ischemic electrocardiogram changes, confirmed myocardial infarction, angiographic stenosis >= 50%, revascularization, or CAD death. Cholesterol in the HDL fraction and HDL3 cholesterol subfraction was measured enzymatically after precipitation with heparin/manganese and dextran sulfate, respectively.RESULTS: During 18 years of follow-up, 29.5% of men and 25.5% of women developed CAD. Although a linear decrease in incidence was observed with increasing HDL-C concentration in men, incidence increased in women at less than 47 mg/dL and greater than 80 mg/dL. These patterns largely reflected the HDL3 cholesterol-CAD association. After multivariable adjustment, the linear, inverse, HDL-C/CAD association persisted in men (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.94-0.99); in women, the U-shaped relationship lost significance. HDL3 cholesterol remained multivariably associated with CAD in both men (linear association, P = .03) and women (HR 2.31 (95% CI 1.31-4.08) and HR 1.80 (95% CI 1.01-3.23) for the lowest and highest versus the middle quintiles, respectively).CONCLUSION: The increased CAD risk in women for an HDL-C >80 mg/dL in type 1 diabetes merits further study. Gender specificity could not be determined as only two men had HDL-C >80 mg/dL. (C) 2011 National Lipid Association. All rights reserved.