JOINT EFFECTS OF SERUM TRIGLYCERIDE AND LDL CHOLESTEROL AND HDL CHOLESTEROL CONCENTRATIONS ON CORONARY HEART-DISEASE RISK IN THE HELSINKI HEART-STUDY - IMPLICATIONS FOR TREATMENT
JOINT EFFECTS OF SERUM TRIGLYCERIDE AND LDL CHOLESTEROL AND HDL CHOLESTEROL CONCENTRATIONS ON CORONARY HEART-DISEASE RISK IN THE HELSINKI HEART-STUDY - IMPLICATIONS FOR TREATMENT
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DOI：
10.1161/01.cir.85.1.37
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发表时间：
1992-01-01
期刊：
影响因子：
37.8
通讯作者：
FRICK, MH
中科院分区：
文献类型：
--
作者：
MANNINEN, V;TENKANEN, L;FRICK, MH
背景。 我们在赫尔辛基心脏研究的试验组（n = 4,081）中研究了基线甘油三酯和脂蛋白胆固醇水平对心脏终点事件发生率的联合影响，赫尔辛基心脏研究是一项在血脂异常中年男性中进行的为期 5 年的随机冠状动脉一级预防试验。 使用具有虚拟变量技术的 Cox 比例风险模型计算相对风险 (RR)，该技术允许同时研究安慰剂组和治疗组的亚组组合。方法和结果。 在安慰剂组（n = 2,045）中，低密度脂蛋白胆固醇（LDL-C）/高密度脂蛋白胆固醇（HDL-C）比率是心脏事件的最佳单一预测因子。 该比率与血清甘油三酯水平相结合揭示了一个高风险亚组：与LDL-C/HDL-C比率小于或等于5且甘油三酯浓度的受试者相比，LDL-C/HDL-C比率> 5且甘油三酯> 2.3 mmol/l的受试者的RR为3.8（95% CI，2.2-6.6） 小于或等于 2.3 mmol/l。 在甘油三酯浓度> 2.3 mmol/l且LDL-C/HDL-C比值小于或等于5的受试者中，RR接近于1（1.1），而在甘油三酯水平小于或等于2.3 mmol/l且LDL-C/HDL-C比值> 5的受试者中，RR为1.2。 LDL-C/HDL-C比值> 5且甘油三酯水平> 2.3 mmol/l的高危组从吉非贝齐治疗中获益最多，其冠心病事件发生率比相应的安慰剂亚组低71%。 在所有其他亚组中，冠心病发病率的降低幅度要小得多。结论。 血清甘油三酯浓度对于评估冠心病风险和预测吉非贝齐治疗效果均具有预后价值，尤其是与 HDL-C 和 LDL-C 联合使用时。
Background. We studied the joint effect of baseline triglyceride and lipoprotein cholesterol levels on the incidence of cardiac end points in the trial group (n = 4,081) of the Helsinki Heart Study, a 5-year randomized coronary primary prevention trial among dyslipidemic middle-aged men. The relative risks (RR) were calculated using Cox proportional hazards models with a dummy variable technique that allows simultaneous study of subgroup combinations from the placebo and treatment groups.Methods and Results. In the placebo group (n = 2,045), the low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio was the best single predictor of cardiac events. This ratio in combination with the serum triglyceride level revealed a high-risk subgroup: subjects with LDL-C/HDL-C ratio > 5 and triglycerides > 2.3 mmol/l had a RR of 3.8 (95% CI, 2.2-6.6) compared with those with LDL-C/HDL-C ratio less-than-or-equal-to 5 and triglyceride concentration less-than-or-equal-to 2.3 mmol/l. In subjects with triglyceride concentration > 2.3 mmol/l and LDL-C/HDL-C ratio less-than-or-equal-to 5, RR was close to unity (1.1), whereas in those with triglyceride level less-than-or-equal-to 2.3 mmol/l and LDL-C/HDL-C ratio > 5, RR was 1.2. The high-risk group with LDL-C/HDL-C ratio > 5 and triglyceride level > 2.3 mmol/l profited most from treatment with gemfibrozil, with a 71% lower incidence of coronary heart disease events than the corresponding placebo subgroup. In all other subgroups, the reduction in CHD incidence was substantially smaller.Conclusions. Serum triglyceride concentration has prognostic value, both for assessing coronary heart disease risk and in predicting the effect of gemfibrozil treatment, especially when used in combination with HDL-C and LDL-C.