Apolipoprotein B/A-I and total cholesterol/high-density lipoprotein cholesterol ratios both predict cardiovascular events in the general population independently of nonlipid risk factors, albuminuria and C-reactive protein
Apolipoprotein B/A-I and total cholesterol/high-density lipoprotein cholesterol ratios both predict cardiovascular events in the general population independently of nonlipid risk factors, albuminuria and C-reactive protein
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DOI：
10.1111/j.1365-2796.2010.02323.x
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发表时间：
2011-02-01
影响因子：
11.1
通讯作者：
Dullaart, R. P. F.
中科院分区：
文献类型：
--
作者：
Kappelle, P. J. W. H.;Gansevoort, R. T.;Dullaart, R. P. F.
背景：总胆固醇/高密度脂蛋白胆固醇（TC/HDL-C）和载脂蛋白（apo）B/A-I比值可预测主要不良心血管事件（MACE）。高敏C反应蛋白（hs-CRP）和白蛋白尿在多大程度上改变了这些相关性，这在很大程度上是未知的。我们比较了这些比率与普通人群中首次MACE的强度，并确定在考虑这些风险标志物时这些关联是否仍然存在。受试者和方法。在6948例既往无心血管疾病且最初未使用降脂药物的受试者（PREVEND队列）中进行了前瞻性病例队列研究。在基线时测量空腹血清TC、低密度脂蛋白胆固醇（LDL-C）、HDL-C、非HDL-C、apoB、apoA-I、甘油三酯、hs-CRP和白蛋白尿。结果：在7.9年的随访中，共有362例首次心血管事件发生。在年龄和性别校正的考克斯比例风险分析中，所有促动脉粥样硬化和抗动脉粥样硬化的脂蛋白指标和预测MACE的指标（P = 0.018至P < 0.001）。apoB/apoA-I比值经年龄和性别校正的风险比（HR）为1.37 [95%置信区间（CI），1.26-1.48]，TC/HDL-C比值为1.24（95% CI，1.18-1.29）（均P < 0.001）。在对甘油三酯水平进行额外调整后，这些关系基本上没有改变。配对比较显示，这些比率在年龄和性别调整分析中具有相似的重要性（P = 0.397）。apoB/apoA-I的HR（P < 0.001）和TC/HDL-C通过额外控制传统风险因素，仅略微降低了主要心脏事件的风险（P < 0.001）结论：在一般人群中，第一次MACE与空腹血清apoB/apoA-I比值和TC/HDL-C比值相关，与甘油三酯无关，hs-CRP和蛋白尿。
Background.The total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) and apolipoprotein (apo) B/A-I ratios predict major adverse cardiovascular events (MACEs). The extent to which these associations are modified by high-sensitivity C-reactive protein (hs-CRP) and albuminuria is largely unknown. We compared the strength of these ratios with first MACE in the general population and determined whether these associations remain when taking account of these risk markers.Subjects and methods.A prospective case-cohort study was performed among 6948 subjects (PREVEND cohort) without previous cardiovascular disease and who did not use lipid-lowering drugs initially. Fasting serum TC, low-density lipoprotein cholesterol (LDL-C), HDL-C, non-HDL-C, apoB, apoA-I, triglycerides, hs-CRP and albuminuria were measured at baseline. The composite endpoint was incident MACE.Results.A total of 362 first cardiovascular events occurred during 7.9 years of follow-up. All pro- and anti-atherogenic measures of lipoproteins and apos predicted MACEs in age- and sex-adjusted Cox proportional hazard analyses (P = 0.018 to P < 0.001). The age- and sex-adjusted hazard ratio (HR) was 1.37 [95% confidence interval (CI), 1.26-1.48] for the apoB/apoA-I ratio and 1.24 (95% CI, 1.18-1.29) for the TC/HDL-C ratio (both P < 0.001). These relationships were essentially unaltered after additional adjustment for triglyceride levels. Pair-wise comparison revealed that these ratios were of similar importance in age- and sex-adjusted analysis (P = 0.397). The HRs of apoB/apoA-I (P < 0.001) and TC/HDL-C (P < 0.001) for risk of MACEs were only marginally attenuated by additional controlling for traditional risk factors (hypertension, diabetes, obesity and smoking), hs-CRP and albuminuria.Conclusions.First MACE is associated with both the fasting serum apoB/apoA-I ratio and the TC/HDL-C ratio in the general population, independently of triglycerides, hs-CRP and albuminuria.