HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events
HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events
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DOI：
10.1056/nejmoa064278
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发表时间：
2007-09-27
影响因子：
158.5
通讯作者：
Fruchart, Jean-Charles
中科院分区：
文献类型：
--
作者：
Barter, Philip;Gotto, Antonio M.;Fruchart, Jean-Charles
背景：高密度脂蛋白（HDL）胆固醇水平是心血管事件的一个强有力的反向预测因子。然而，目前尚不清楚这种关联是否在低密度脂蛋白（LDL）胆固醇水平非常低的情况下维持。方法对近期完成的TNT （treatment to New Targets）研究进行事后分析，评估9770例患者高密度脂蛋白胆固醇水平的预测价值。主要结局指标是发生第一次主要心血管事件的时间，定义为冠心病死亡、非致死性非手术相关心肌梗死、心脏骤停后复苏、致死性或非致死性中风。通过单因素和多因素分析评估了他汀类药物治疗第3个月时HDL胆固醇水平与第一次主要心血管事件发生时间之间的预测关系，并评估了特定LDL胆固醇水平，包括LDL胆固醇水平低于70 mg / dl （1.8 mmol / l）的受试者。结果在TNT研究队列中，接受他汀类药物治疗的患者的高密度脂蛋白胆固醇水平可以预测主要心血管事件，无论是当高密度脂蛋白胆固醇被认为是一个连续变量时，还是当受试者按照高密度脂蛋白胆固醇水平的五分位数分层时。按他汀类药物患者LDL胆固醇水平分层分析时，HDL胆固醇水平与主要心血管事件的关系具有临界意义（P=0.05）。即使在低密度脂蛋白胆固醇水平低于每分升70毫克的研究对象中，高密度脂蛋白胆固醇水平最高的五分位数的人发生主要心血管事件的风险也低于最低五分位数的人（P=0.03）。结论：在这项事后分析中，高密度脂蛋白胆固醇水平可预测他汀类药物治疗患者的主要心血管事件。在低密度脂蛋白胆固醇水平低于每分升70毫克的患者中也观察到这种关系。
BackgroundHigh-density lipoprotein (HDL) cholesterol levels are a strong inverse predictor of cardiovascular events. However, it is not clear whether this association is maintained at very low levels of low-density lipoprotein (LDL) cholesterol.MethodsA post hoc analysis of the recently completed Treating to New Targets (TNT) study assessed the predictive value of HDL cholesterol levels in 9770 patients. The primary outcome measure was the time to a first major cardiovascular event, defined as death from coronary heart disease, nonfatal non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. The predictive relationship between HDL cholesterol levels at the third month of treatment with statins and the time to the first major cardiovascular event was assessed in univariate and multivariate analyses and was also assessed for specific LDL cholesterol strata, including subjects with LDL cholesterol levels below 70 mg per deciliter (1.8 mmol per liter).ResultsThe HDL cholesterol level in patients receiving statins was predictive of major cardiovascular events across the TNT study cohort, both when HDL cholesterol was considered as a continuous variable and when subjects were stratified according to quintiles of HDL cholesterol level. When the analysis was stratified according to LDL cholesterol level in patients receiving statins, the relationship between HDL cholesterol level and major cardiovascular events was of borderline significance (P=0.05). Even among study subjects with LDL cholesterol levels below 70 mg per deciliter, those in the highest quintile of HDL cholesterol level were at less risk for major cardiovascular events than those in the lowest quintile (P=0.03).ConclusionsIn this post hoc analysis, HDL cholesterol levels were predictive of major cardiovascular events in patients treated with statins. This relationship was also observed among patients with LDL cholesterol levels below 70 mg per deciliter.