Evidence that triglycerides are an independent coronary heart disease risk factor
Evidence that triglycerides are an independent coronary heart disease risk factor
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DOI：
10.1016/s0002-9149(00)01127-9
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发表时间：
2000-11-01
影响因子：
2.8
通讯作者：
Cullen, P
中科院分区：
文献类型：
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作者：
Cullen, P
过去，高脂血症与冠心病（CHD）的关系一直不确定。然而，最近对来自大规模前瞻性心血管Munster研究的8年随访数据进行的多变量分析发现，在控制低密度脂蛋白（LDL）和高密度脂蛋白（HDL）胆固醇后，高甘油三酯血症是主要冠状动脉事件的独立风险因素，高甘油三酯血症合并LDL胆固醇升高和高LDL：高密度脂蛋白胆固醇比率（>5）增加冠心病事件的风险约6倍，同样，一项对17项前瞻性试验的大型荟萃分析报告，高甘油三酯血症是心血管疾病的独立危险因素。在这项研究中，血浆甘油三酯水平升高88 mg/dl（1.0 mmol/L）可显著增加心血管疾病的相对风险，男性约为30%，女性约为75%;相应的比率略低（14%和37%），但在调整HDL胆固醇水平后仍具有统计学显著性。赫尔辛基心脏研究和斯德哥尔摩缺血性心脏研究中患者的这些数据和观察结果表明，降脂药物治疗期间最大的冠状动脉获益发生在高甘油三酯血症患者中，这有力地证明了高甘油三酯血症在CHD风险中的独立作用。在最近的退伍军人事务部合作研究项目高密度脂蛋白胆固醇干预试验中，使用吉非罗齐提高HDL胆固醇水平和降低甘油三酯水平而不降低LDL胆固醇水平可减少已确诊CHD男性的冠状动脉事件，而苯扎贝特梗死预防试验的初步结果表明，基线甘油三酯水平升高的患者冠状动脉终点减少。为了尽可能降低CHD风险，抗高血脂治疗策略还应旨在降低升高的甘油三酯，（C）2000，Excerpta Medica，Inc.
In the past, the relation between hypertriglyceridemia and coronary heart disease (CHD) has been uncertain. However, a recent multivariate analysis of 8-year follow-up data from the large-scale Prospective Cardiovascular Munster study found hypertriglyceridemia to be an independent risk factor for major coronary events after controlling for low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, Hypertriglyceridemia combined with elevated LDL cholesterol and high LDL:HDL cholesterol ratio (>5) increased the CHD event risk by approximately sixfold, Similarly, a large metaanalysis of 17 prospective trials reported hypertriglyceridemia to be an independent risk factor for cardiovascular disease. In this study, an 88 mg/dl (1.0 mmol/L) increase in plasma triglyceride levels significantly increased the relative risk of cardiovascular disease by approximate to 30% in men and 75% in women; the corresponding rates were somewhat lower (14% and 37%) but still statistically significant after adjustment for HDL cholesterol level. These data and observations from patients in the Helsinki Heart Study and the Stockholm Ischemic Heart study, that the greatest coronary benefit during lipid-lowering drug therapy occurred among hypertriglyceridemic patients, argue strongly for an independent role for hypertriglyceridemia in CHD risk. In the recent Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial, the use of gemfibrozil to raise HDL cholesterol levels and lower levels of triglycerides without lowering LDL cholesterol levels reduced coronary events in men with established CHD, whereas preliminary results from the Bezafibrate Infarction Prevention Trial indicate a reduction in coronary end points in patients with elevated baseline triglyceride levels. To achieve the greatest possible reduction in CHD risk, antihyperlipidemic treatment strategies should also be aimed at reducing elevated triglycerides, (C)2000 by Excerpta Medica, Inc.