A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction.
A prospective study of triglyceride level, low-density lipoprotein particle diameter, and risk of myocardial infarction.
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DOI：
10.1001/jama.1996.03540110036029
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发表时间：
1996-09
期刊：
影响因子：
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通讯作者：
M. Stampfer;R. Krauss;Jing Ma;P. Blanche;L. Holl;F. Sacks;C. Hennekens
中科院分区：
文献类型：
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作者：
M. Stampfer;R. Krauss;Jing Ma;P. Blanche;L. Holl;F. Sacks;C. Hennekens
目的 检验小而密的低密度脂蛋白（LDL）颗粒占优势以及甘油三酯水平升高是否为心肌梗死（MI）的独立危险因素。
设计 采用前瞻性收集样本的巢式病例对照研究。
设置 前瞻性队列研究。
参与者 在医师健康研究中，从14916名40至84岁的男性中在基线时采集血液样本（85%为非空腹样本）。
主要观察指标 在7年随访期间诊断出的心肌梗死。
结果 病例组（n = 266）的LDL直径（均值[标准差]，25.6[0.9]纳米）显著小于年龄和吸烟状况相匹配的对照组（n = 308）（均值[标准差]，25.9[0.8]纳米；P <.001）。病例组的甘油三酯中位数水平也较高（1.90比1.49毫摩尔/升[168比132毫克/分升]；P <.001）。LDL直径与甘油三酯水平呈高度负相关（r = -0.71），与高密度脂蛋白胆固醇（HDL - C）水平呈高度正相关（r = 0.60）。我们观察到甘油三酯和总胆固醇（TC）水平之间存在显著的相乘交互作用（P =.01）。在同时对血脂和多种冠心病危险因素进行调整后，LDL颗粒直径不再是具有统计学意义的风险指标，每减少0.8纳米，相对风险（RR）为1.09（95%置信区间[CI]，0.85 - 1.40）。然而，甘油三酯水平仍然具有显著意义，每增加1.13毫摩尔/升（100毫克/分升），RR为1.40（95%CI，1.10 - 1.77）。甘油三酯水平与MI风险之间的关联在整个分布中呈线性；处于最高五分位数的男性的风险约为处于最低五分位数男性的2.5倍。总胆固醇水平（而非HDL - C水平）也仍然具有显著意义，每增加1.03毫摩尔/升（40毫克/分升），RR为1.80（95%CI，1.44 - 2.26）。
结论 这些研究结果表明，非空腹甘油三酯水平似乎是未来MI风险的一个强有力的独立预测因子，特别是当总胆固醇水平也升高时。相比之下，LDL颗粒直径与MI风险相关，但在对甘油三酯水平进行调整后则无相关性。甘油三酯水平升高、LDL颗粒直径变小以及HDL - C水平降低似乎反映了潜在的代谢紊乱，对MI风险具有不良影响；升高的甘油三酯水平可能有助于识别高危个体。
OBJECTIVE To test whether a predominance of small, dense low-density lipoprotein (LDL) particles and elevated triglyceride levels are independent risk factors for myocardial infarction (MI). DESIGN Nested case-control study with prospectively collected samples. SETTING Prospective cohort study. PARTICIPANTS Blood samples were collected at baseline (85% nonfasting samples) from 14916 men aged 40 to 84 years in the Physicians' Health Study. MAIN OUTCOME MEASUREMENTS Myocardial infarction diagnosed during 7 years of follow-up. RESULTS Cases (n=266) had a significantly smaller LDL diameter (mean [SD], 25.6 [0.9] nm) than did controls (n=308) matched on age and smoking (mean [SD], 25.9 [8] nm; P<.001). Cases also had higher median triglyceride levels (1.90 vs 1.49 mmol/L [168 vs 132 mg/dL]; P<.001). The LDL diameter had a high inverse correlation with triglyceride level (r=-0.71), and a high direct correlation with high-density lipoprotein cholesterol (HDL-C) level (r=0.60). We observed a significant multiplicative interaction between triglyceride and total cholesterol (TC) levels (P=.01). After simultaneous adjustment for lipids and a variety of coronary risk factors, LDL particle diameter was no longer a statistically significant risk indicator, with a relative risk (RR) of 1.09 (95% confidence interval [CI], 0.85-1.40) per 0.8-nm decrease. However, triglyceride level remained significant with an RR of 1.40 (95% CI, 1.10-1.77) per 1.13 mmol/L (100-mg/dL) increase. The association between triglyceride level and MI risk appeared linear across the distribution; men in the highest quintile had a risk about 2.5 times that of those in the lowest quintile. The TC level, but not HDL-C level, also remained significant, with an RR of 1.80 (95% CI, 1.44-2.26) per 1.03-mmol/L (40-mg/dL) increase. CONCLUSIONS These findings indicate that nonfasting triglyceride levels appear to be a strong and independent predictor of future risk of MI, particularly when the total cholesterol level is also elevated. In contrast, LDL particle diameter is associated with risk of MI, but not after adjustment for triglyceride level. Increased triglyceride level, small LDL particle diameter, and decreased HDL-C levels appear to reflect underlying metabolic perturbations with adverse consequences for risk of MI; elevated triglyceride levels may help identify high-risk individuals.