VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins
VLDL Cholesterol Accounts for One-Half of the Risk of Myocardial Infarction Associated With apoB-Containing Lipoproteins
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DOI：
10.1016/j.jacc.2020.09.610
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发表时间：
2020-12-08
影响因子：
24
通讯作者：
Nordestgaard, Borge G.
中科院分区：
文献类型：
--
作者：
Balling, Mie;Afzal, Shoaib;Nordestgaard, Borge G.
血浆载脂蛋白B （apoB）是所有引起动脉粥样硬化性心血管疾病的载脂蛋白的综合测量；然而，目前尚不清楚极低密度脂蛋白（vldl）中的胆固醇和甘油三酯分别解释了哪一部分风险。目的：作者验证了VLDL胆固醇和甘油三酯各自解释了含载脂蛋白脂蛋白的部分心肌梗死风险的假设。方法：在哥本哈根普通人群研究的109751名个体中，作者在研究开始时检查了25480名未接受降脂治疗和心肌梗死的受试者。所有患者均测量血浆载脂蛋白ob（载脂蛋白定量计数）和VLDL、中密度脂蛋白（idl）和低密度脂蛋白（ldl）的胆固醇和甘油三酯含量。结果：在中位11年的随访期间，1816名患者被诊断为心肌梗死。每升高1 mmol/l， VLDL胆固醇的多变量校正心肌梗死风险比为2.07(95%可信区间[CI]: 1.81至2.36)，VLDL甘油三酯为1.19(95%可信区间[CI]: 1.14至1.25)，IDL胆固醇为5.38 (95% CI: 3.73至7.75)，LDL胆固醇为1.86 （95% CI: 1.62至2.14）。血浆载脂蛋白每升高1 g/l，相应值为2.21 （95% CI: 1.90 ~ 2.58）。在加速Cox回归中，心肌梗死的危险因素按重要性划分为VLDL胆固醇、收缩压、吸烟和IDL + LDL胆固醇，而VLDL甘油三酯没有进入模型。VLDL胆固醇和IDL + LDL胆固醇分别解释了载脂蛋白脂蛋白引起心肌梗死的50%和29%的风险，而VLDL甘油三酯不能解释风险。结论：VLDL胆固醇解释了含载脂蛋白升高引起的一半心肌梗死风险，而VLDL甘油三酯不能解释风险。(C) 2020由爱思唯尔代表美国心脏病学会基金会出版。
BACKGROUND Plasma apolipoprotein B (apoB) is a composite measure of all apoB-containing lipoproteins causing atherosclerotic cardiovascular disease; however, it is unclear which fraction of risk is explained by cholesterol and triglycerides, respectively, in very low-density lipoproteins (VLDLs).OBJECTIVES The authors tested the hypothesis that VLDL cholesterol and triglycerides each explain part of the myocardial infarction risk from apoB-containing lipoproteins.METHODS Nested within 109,751 individuals from the Copenhagen General Population Study, the authors examined 25,480 subjects free of lipid-lowering therapy and myocardial infarction at study entry. All had measurements of plasma apoB (quantitating number of apoB-containing lipoproteins) and cholesterol and triglyceride content of VLDL, intermediate-density lipoproteins (IDLs), and low-density lipoproteins (LDLs).RESULTS During a median 11 years of follow-up, 1,816 were diagnosed with myocardial infarction. Per 1-mmol/l higher levels, multivariable-adjusted hazard ratios for myocardial infarction were 2.07 (95% confidence interval [CI]: 1.81 to 2.36) for VLDL cholesterol, 1.19 (95% CI: 1.14 to 1.25) for VLDL triglycerides, 5.38 (95% CI: 3.73 to 7.75) for IDL cholesterol, and 1.86 (95% CI: 1.62 to 2.14) for LDL cholesterol. Per 1-g/l higher plasma apoB, the corresponding value was 2.21 (95% CI: 1.90 to 2.58). In a step-up Cox regression, risk factors for myocardial infarction entered by importance as VLDL cholesterol, systolic blood pressure, smoking, and IDL + LDL cholesterol, whereas VLDL triglycerides did not enter the model. VLDL cholesterol explained 50% and IDL + LDL cholesterol 29% of the risk of myocardial infarction from apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk.CONCLUSIONS VLDL cholesterol explained one-half of the myocardial infarction risk from elevated apoB-containing lipoproteins, whereas VLDL triglycerides did not explain risk. (C) 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.