Search for an optimal atherogenic lipid risk profile: From the Framingham study
Search for an optimal atherogenic lipid risk profile: From the Framingham study
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DOI：
10.1016/j.amjcard.2005.08.055
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发表时间：
2006-02-01
影响因子：
2.8
通讯作者：
D'Agostino, RB
中科院分区：
文献类型：
--
作者：
Nam, BH;Kannel, WB;D'Agostino, RB
最近的指南针对低密度脂蛋白（LDL）胆固醇治疗血脂异常。缺乏明确的划分潜在的冠心病（CHD）的情况下，仅根据低密度脂蛋白胆固醇表明，需要考虑血脂异常的风险，在脂质和风险因素的情况下。我们前瞻性地研究了2,439名男性和2,812名女性在20年的冠心病发展中个体脂质及其比例的影响。在LDL胆固醇和总胆固醇水平的三分位数中检查总/高密度（HDL）胆固醇比率对CHD风险的影响。在20年期间，男性发生了566例CHD事件，女性发生了327例CHD事件。无论总胆固醇水平或低密度脂蛋白胆固醇水平如何，从总胆固醇/高密度脂蛋白胆固醇比率的第一到第三个三分位数，男性和女性的冠心病风险逐步增加2到3倍。在男性中，低密度脂蛋白胆固醇水平反映了最低的风险因素调整五分之一至五分之一的相对风险（1.85），总/高密度脂蛋白胆固醇比率预测的风险最大（相对风险2.9）。在女性中，低密度脂蛋白胆固醇赋予个体脂质的最高风险（相对风险3.9），并且脂质比率未超过该风险（相对风险3.8）。总胆固醇/高密度脂蛋白胆固醇比值各组分水平对冠心病的预测作用不大。在男性中，如果总/HDL胆固醇比率低，则不需要积极治疗LDL升高。相反，如果比率高，LDL的适度升高可能需要更积极的治疗。在女性中，该比率也是一个很好的CHD预测因子，但高比率伴随高LDL胆固醇的组合可能需要更积极的治疗。(c)2006年爱思唯尔公司All rights reserved.
Recent guidelines have targeted low-density lipoprotein (LDL) cholesterol for treatment of dyslipidemia. A lack of clear demarcation of potential coronary heart disease (CHD) cases solely on the basis of LDL cholesterol indicates the need to consider the dyslipidemic risk in the context of a lipid and risk factor profile. We prospectively examined the influence of individual lipids and their ratios on 20-year CHD development in 2,439 men and 2,812 women participating in the Framingham Offspring Study. The influence of the total/high-density (HDL) cholesterol ratio on CHD risk was examined in tertiles of LDL cholesterol and total cholesterol levels. During the 20-year period, 566 CHD events occurred in men and 327 events in women. The CHD risk increased stepwise two- to threefold in men and women from the first to third tertile of total/HDL cholesterol ratio, irrespective of the level of total or LDL cholesterol level. In men, the LDL cholesterol level reflected the lowest risk factor adjusted quintile 5 to quintile 1 relative risk (1.85), and the total/HDL cholesterol ratio predicted the greatest risk (relative risk 2.9). In women, LDL cholesterol imparted the highest risk of the individual lipids (relative risk 3.9), and this was not exceeded by the lipid ratio (relative risk 3.8). In conclusion, the levels of components of the total/HDL cholesterol ratio have little influence on its prediction of CHD. In men, elevated LDL need not be treated aggressively if the total/HDL cholesterol ratio is low. Conversely, modest elevations of LDL may warrant more aggressive treatment if the ratio is high. In women, the ratio is also a good CHD predictor, but a combination of a high ratio accompanied by high LDL cholesterol may warrant more aggressive therapy. (c) 2006 Elsevier Inc. All rights reserved.