Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up
Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up
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DOI：
10.1111/j.1365-2796.2010.02333.x
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发表时间：
2011-07-01
影响因子：
11.1
通讯作者：
Nordestgaard, B. G.
中科院分区：
文献类型：
--
作者：
Langsted, A.;Freiberg, J. J.;Nordestgaard, B. G.
Langsted A, Freiberg JJ, tybjager - hansen A, Schnohr P, Jensen GB, Nordestgaard BG （Herlev医院，Herlev；哥本哈根大学；Bispebjerg医院；丹麦哥本哈根Rigshospitalet）。非空腹胆固醇和甘油三酯与心肌梗死风险和总死亡率的关系：哥本哈根市心脏研究31年随访实习医学杂志2011；270: 65 - 75. -目标。我们比较了非常高水平的非空腹胆固醇和甘油三酯预测心肌梗死风险和总死亡率的能力。从1976年至1978年至2007年的前瞻性研究。丹麦普通人群。参与者。随机选取7581名女性和6391名男性，其中768名和1151名发生心肌梗死，4398名和4416名死亡。参与率72%，随访完成率100%。不到2%的参与者正在接受降脂治疗。与胆固醇< 5 mmol L-1的女性相比，胆固醇水平为5.0-5.99 mmol L-1的女性心肌梗死的多变量调整风险比为1.3[95%可信区间（CI）： 0.9-1.8]，胆固醇水平为9 mmol L-1的女性心肌梗死的多变量调整风险比为2.5(95%可信区间（CI）： 1.6-4.0)（趋势：P < 0.0001）。与非空腹甘油三酯< 1 mmol L) 1的妇女相比，甘油三酯1.0-1.99 mmol L-1的妇女心肌梗死的风险比为1.5 (95% CI: 1.2-1.8)，甘油三酯>= 5 mmol L-1的妇女心肌梗死的风险比为4.2 (95% CI: 2.5-7.2) （p < 0.0001）。在男性中，相应的胆固醇风险比为1.2 （95% CI: 1.0-1.5）至5.3 (95% CI: 3.6-8.0) (P < 0.0001)，甘油三酯风险比为1.3 （95% CI: 1.0-1.6）至2.1 (95% CI: 1.5-2.8) （P < 0.0001）。在女性（趋势：P = 0.39）或男性（P = 0.02）中，胆固醇水平升高与总死亡率并不一致。相比之下，与甘油三酯< 1 mmol L-1的女性相比，甘油三酯1.0-1.99 mmol L-1的女性总死亡率的多变量调整危险比为1.1 (95% CI: 1.0-1.2)，甘油三酯>= 5 mmol L-1的女性总死亡率的多变量调整危险比为2.0 (95% CI: 1.5-2.9)（趋势：P < 0.0001）；男性相应的风险比范围为1.1 （95% CI: 1.0-1.2）至1.5 (95% CI: 1.2-1.7) （P < 0.0001）。非空腹胆固醇和非空腹甘油三酯水平的逐步增加与心肌梗死风险的逐步增加相似，非空腹甘油三酯是女性的最佳预测因子，非空腹胆固醇是男性的最佳预测因子。更令人惊讶的是，只有非空腹甘油三酯水平的增加与总死亡率有关，而胆固醇水平的增加与总死亡率无关。
Langsted A, Freiberg JJ, Tybjaerg-Hansen A, Schnohr P, Jensen GB, Nordestgaard BG (Herlev Hospital, Herlev; University of Copenhagen; Bispebjerg Hospital; and Rigshospitalet, Copenhagen O, Denmark). Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up. J Intern Med 2011; 270: 65-75.Objectives. We compared the ability of very high levels of nonfasting cholesterol and triglycerides to predict risk of myocardial infarction and total mortality.Design. Prospective study from 1976 to 1978 until 2007.Setting. Danish general population.Participants. Randomly selected population of 7581 women and 6391 men, of whom 768 and 1151 developed myocardial infarction and 4398 and 4416 died, respectively. Participation rate was 72%, and follow-up was 100% complete. Less than 2% of participants were taking lipid-lowering therapy.Results. Compared to women with cholesterol < 5 mmol L-1, multivariate-adjusted hazard ratios for myocardial infarction ranged from 1.3 [95% confidence interval (CI): 0.9-1.8] for a cholesterol level of 5.0-5.99 mmol L-1 to 2.5 (95% CI: 1.6-4.0) for cholesterol >= 9 mmol L-1 (trend: P < 0.0001). Compared with women with nonfasting triglycerides < 1 mmol L) 1, hazard ratios for myocardial infarction ranged from 1.5 (95% CI: 1.2-1.8) for triglycerides of 1.0-1.99 mmol L-1 to 4.2 (95% CI: 2.5-7.2) for triglycerides >= 5 mmol L-1 (p < 0.0001). In men, corresponding hazard ratios ranged from 1.2 (95% CI: 1.0-1.5) to 5.3 (95% CI: 3.6-8.0) for cholesterol (P < 0.0001) and from 1.3 (95% CI: 1.0-1.6) to 2.1 (95% CI: 1.5-2.8) for triglycerides (P < 0.0001). Increasing cholesterol levels were not consistently associated with total mortality in women (trend: P = 0.39) or men (P = 0.02). By contrast, compared with women with triglycerides < 1 mmol L-1, multivariate-adjusted hazard ratios for total mortality ranged from 1.1 (95% CI: 1.0-1.2) for triglycerides of 1.0-1.99 mmol L-1 to 2.0 (95% CI: 1.5-2.9) for triglycerides >= 5 mmol L-1 (trend: P < 0.0001); corresponding hazard ratios in men ranged from 1.1 (95% CI: 1.0-1.2) to 1.5 (95% CI: 1.2-1.7) (P < 0.0001).Conclusions. Stepwise increasing levels of nonfasting cholesterol and nonfasting triglycerides were similarly associated with stepwise increasing risk of myocardial infarction, with nonfasting triglycerides being the best predictor in women and nonfasting cholesterol the best predictor in men. Even more surprisingly, only increasing levels of nonfasting triglycerides were associated with total mortality, whereas increasing cholesterol levels were not.