Relation of black race between high density lipoprotein cholesterol content, high density lipoprotein particles and coronary events (from the Dallas Heart Study).
Relation of black race between high density lipoprotein cholesterol content, high density lipoprotein particles and coronary events (from the Dallas Heart Study).
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DOI：
10.1016/j.amjcard.2015.01.015
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发表时间：
2015-04-01
期刊：
影响因子：
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通讯作者：
Rohatgi A
中科院分区：
文献类型：
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作者：
Chandra A;Neeland IJ;Das SR;Khera A;Turer AT;Ayers CR;McGuire DK;Rohatgi A
以高密度脂蛋白胆固醇含量（HDL - C）为靶向的治疗并未改善冠心病（CHD）的预后。高密度脂蛋白颗粒浓度（HDL - P）可能更好地预测冠心病。然而，种族/族裔对HDL - P与亚临床动脉粥样硬化/冠心病发病事件之间关系的影响尚未有相关描述。达拉斯心脏研究的参与者是达拉斯县成年人的一个多种族、基于概率的人群队列，他们进行了以下基线测量：通过核磁共振成像（NMR）测量HDL - C、HDL - P，以及通过电子束计算机断层扫描测量冠状动脉钙化（CAC）。参与者被随访了中位数为9.3年以观察冠心病发病事件（首次心肌梗死、中风、冠状动脉血运重建或心血管死亡的复合情况）。该研究包括1977名无冠心病的参与者（51%为女性，46%为黑人）。在调整后的模型中，HDL - C与普遍存在的CAC无关（p = 0.13），与总体冠心病发病也无关（每1个标准差的风险比：0.89，95%置信区间0.76 - 1.05）。然而，HDL - C在非黑人中与冠心病发病呈负相关（每1个标准差调整后的风险比为0.67，95%置信区间0.46 - 0.97），但在黑人参与者中并非如此（风险比0.94，95%置信区间0.78 - 1.13，交互作用p值 = 0.05）。相反，在对风险因素和HDL - C进行调整后，HDL - P与普遍存在的CAC呈负相关（p = 0.009），且与总体冠心病发病呈负相关（每1个标准差调整后的风险比：0.73，95%置信区间0.62 - 0.86），且不受黑人种族/族裔的交互影响（交互作用p值 = 0.57）。总之，与HDL - C相反，HDL - P与冠心病发病事件之间的负相关关系在不同族裔中是一致的。这些发现表明，在预测不同人群中普遍存在的动脉粥样硬化以及冠心病发病事件方面，HDL - P优于HDL - C，并且应被视为一个治疗靶点。
Therapies targeting high density lipoprotein cholesterol content (HDL-C) have not improved coronary heart disease (CHD) outcomes. HDL particle concentration (HDL-P) may better predict CHD. However, the impact of race/ethnicity on the relations between HDL-P and subclinical atherosclerosis/ incident CHD events has not been described. Participants from the Dallas Heart Study, a multiethnic, probability-based, population cohort of Dallas County adults had the following baseline measurements: HDL-C, HDL-P by nuclear magnetic resonance imaging (NMR), and coronary artery calcium (CAC) by electron beam computed tomography. Participants were followed for a median of 9.3 years for incident CHD events (composite of first myocardial infarction, stroke, coronary revascularization, or cardiovascular death). The study comprised 1977 participants free from CHD (51% women, 46% Black). In adjusted models, HDL-C was not associated with prevalent CAC (p=0.13) or incident CHD overall (HR per 1SD: 0.89, 95% CI 0.76–1.05). However, HDL-C was inversely associated with incident CHD among non-Black (adjusted HR per 1SD 0.67, 95% CI 0.46–0.97) but not Black participants (HR 0.94, 95% CI 0.78–1.13, pinteraction = 0.05). Conversely, HDL-P, adjusted for risk factors and HDL-C, was inversely associated with prevalent CAC (p=0.009) and with incident CHD overall (adjusted HR per 1SD: 0.73, 95% CI 0.62–0.86) with no interaction by Black race/ethnicity (pinteraction = 0.57). In conclusion, in contrast to HDL-C, the inverse relationship between HDL-P and incident CHD events is consistent across ethnicities. These findings suggest that HDL-P is superior to HDL-C in predicting both prevalent atherosclerosis as well as incident CHD events across a diverse population and should be considered as a therapeutic target.