Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.
Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease.
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DOI：
10.1161/circulationaha.114.012477
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发表时间：
2015-02-03
期刊：
影响因子：
37.8
通讯作者：
Pencina MJ
中科院分区：
文献类型：
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作者：
Navar-Boggan AM;Peterson ED;D'Agostino RB Sr;Neely B;Sniderman AD;Pencina MJ
许多患有中度高脂血症的年轻人不符合新的AHA/ACC胆固醇指南下的他汀类药物治疗标准，因为他们关注10年心血管风险。我们评估了成年早期暴露于高胆固醇血症多年与未来冠心病（CHD）风险之间的关系。我们检查了Fragrance后代队列数据，以确定年龄55岁以下无心血管疾病的成年人（n=1478），并探讨了成年早期中度高脂血症（非高密度脂蛋白胆固醇[HDL-C] ≥160 mg/dL）持续时间与随后的CHD之间的关系。在中位15年随访中，55岁时长期暴露于高脂血症的成年人的CHD发生率显著升高：未暴露者为4.4%，1-10年为8.1%，11-20年为16.5（p<0.001）;在校正了包括55岁时的非HDL-C在内的其他心脏危险因素后，这种相关性仍然存在（HR 1.39，95%CI 1.05-1.85/10年高脂血症）。总体而言，根据目前的国家指南，85%患有长期高脂血症的年轻人在40岁时不会被推荐接受他汀类药物治疗。然而，在55岁时未考虑他汀类药物治疗候选者中，青年期高脂血症累积暴露与随后的CHD风险之间仍存在显著相关性（校正HR 1.67，95% CI 1.06-2.64）。青年期高脂血症的累积暴露以剂量依赖性方式增加随后的CHD风险。长期暴露于非HDL-C即使中度升高的成年人未来患冠心病的风险也会增加，并可能从更积极的一级预防中获益。
Many young adults with moderate hyperlipidemia do not meet statin treatment criteria under the new AHA/ACC cholesterol guidelines as they focus on 10-year cardiovascular risk. We evaluated the association between years of exposure to hypercholesterolemia in early adulthood and future coronary heart disease (CHD) risk. We examined Framingham Offspring Cohort data to identify adults without incident cardiovascular disease to age 55 (n=1478), and explored the association between moderate hyperlipidemia (non-high-density lipoprotein cholesterol [HDL-C] ≥160 mg/dL) duration in early adulthood and subsequent CHD. At median 15-year follow-up, CHD rates were significantly elevated among adults with prolonged hyperlipidemia exposure by age 55: 4.4% for those with no exposure, 8.1% for 1–10 years, and 16.5% for those with 11–20 years exposure (p<0.001); this association persisted after adjustment for other cardiac risk factors including non-HDL-C at age 55 (HR 1.39, 95% CI 1.05–1.85 per decade of hyperlipidemia). Overall, 85% of young adults with prolonged hyperlipidemia would not have been recommended for statin therapy at age 40, under current national guidelines. However, among those not considered statin therapy candidates at age 55, there remained a significant association between cumulative exposure to hyperlipidemia in young adulthood and subsequent CHD risk (adjusted HR 1.67, 95% CI 1.06–2.64). Cumulative exposure to hyperlipidemia in young adulthood increases subsequent risk of CHD in a dose-dependent fashion. Adults with prolonged exposure to even moderate elevations in non-HDL-C have elevated risk for future CHD and may benefit from more aggressive primary prevention.