Coronary artery disease risk in familial combined - Hyperlipidemia and familial hypertriglyceridemia - A case-control comparison from the National Heart, Lung, and Blood Institute Family Heart Study
Coronary artery disease risk in familial combined - Hyperlipidemia and familial hypertriglyceridemia - A case-control comparison from the National Heart, Lung, and Blood Institute Family Heart Study
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DOI：
10.1161/01.cir.0000081777.17879.85
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发表时间：
2003-08-05
期刊：
影响因子：
37.8
通讯作者：
Hunt, SC
中科院分区：
文献类型：
--
作者：
Hopkins, PN;Heiss, G;Hunt, SC
背景-传统观点认为家族性混合型高脂血症（FCHL）比家族性高脂血症（FHTG）有更大的早发冠心病（CAD）风险。然而，没有人口为基础的研究已经严格解决这个问题。方法和结果FCHL和FHTG被诊断为10.2%和12.3%的334个随机对照家庭和16.7%和20.5%的293个家庭至少有一个案件的过早CAD。个体中FCHL或FHTG的诊断与CAD的比值比为2.0相关（分别为P = 0.003和0.002）。然而，与两种血脂紊乱相关的早发CAD的比值比随着高血压、糖尿病，尤其是HDL胆固醇、甘油三酯或载脂蛋白B的进一步校正而显著降低。颈动脉内膜中层厚度和踝肱指数的差异也有类似的结果。代谢综合征在FCHL组和FHTG组中的检出率分别为65%和71%，而在无FCHL或FHTG的对照组中的检出率为19%，比值比为3.3（P < 0.0001）。单独的代谢综合征患病率的增加可以解释与FCHL和FHTG. Conclusions相关的CAD风险升高FCHL和FHTG似乎更相似。此外，FCHL和FHTG的CAD风险与代谢综合征的特征密切相关。这些发现表明FHTG的高脂血症不是良性的，可能需要改变这些脂质紊乱的流行病学、遗传学和临床方法。
Background-Conventional wisdom suggests that a diagnosis of familial combined hyperlipidemia (FCHL) carries a substantially greater risk of premature coronary artery disease (CAD) than a diagnosis of familial hypertriglyceridemia (FHTG). However, no population-based studies have critically addressed this issue.Methods and Results-FCHL and FHTG were diagnosed in 10.2% and 12.3% of 334 random control families and in 16.7% and 20.5% of 293 families with at least one case of premature CAD. The diagnosis of either FCHL or FHTG in an individual was associated with an odds ratio for CAD of 2.0 (P = 0.003 and 0.002, respectively). However, odds ratios for premature CAD associated with both lipid disorders decreased substantially and identically with further adjustment for hypertension, diabetes, and especially HDL cholesterol, triglycerides, or apolipoprotein B. Similar results were found for differences in carotid intima-medial thickness and ankle-brachial index. Metabolic syndrome was identified in 65% of FCHL and 71% of FHTG patients compared with 19% in controls without FCHL or FHTG and was associated with an odds ratio of 3.3 (P < 0.0001). The increased prevalence of the metabolic syndrome alone could account for the elevated CAD risk associated with both FCHL and FHTG.Conclusions-FCHL and FHTG appear more alike than dissimilar. Further, the risk of CAD in FCHL and FHTG was strongly related to features of the metabolic syndrome. These findings suggest that the hypertriglyceridemia in FHTG is not benign and may warrant a change in epidemiological, genetic, and clinical approaches to these lipid disorders.