Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women
Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women
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DOI：
10.1001/jama.298.3.309
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发表时间：
2007-07-18
影响因子：
120.7
通讯作者：
Ridker, Paul M.
中科院分区：
文献类型：
--
作者：
Bansal, Sandeep;Buring, Julie E.;Ridker, Paul M.
背景甘油三酯与心血管疾病的关系仍存在争议。虽然甘油三酯水平通常在空腹状态下获得，但餐后高甘油三酯血症可能在动脉粥样硬化中起重要作用。（空腹与非空腹）和未来心血管事件的风险。设计，设置，对26509名最初健康的美国女性进行的前瞻性研究（20118空腹和6391非空腹）参加妇女健康研究，1992年11月和1995年7月之间登记，并进行了为期11.4年的随访中位数。甘油三酯水平进行了测量，在血液样本中获得的时间enrollment.Main结果测量心血管事件（非致命性心肌梗死，非致命性缺血性中风，冠状动脉血运重建，或心血管死亡hazardratios）。结果在基线，甘油三酯水平在空腹以及非空腹妇女与传统的心脏危险因素和胰岛素抵抗的标志物。在11.4年的中位随访期间，1001名参与者发生了心血管事件（包括276例非致命性心肌梗死，265例缺血性卒中，628例冠状动脉血运重建术和163例心血管死亡），每1000人年随访的总心血管事件发生率为3.46例。在调整年龄、血压、吸烟和激素治疗后，空腹和非空腹甘油三酯水平均能预测心血管事件。在空腹受试者中，进一步调整总胆固醇和高密度脂蛋白胆固醇水平以及胰岛素抵抗指标削弱了这种关联（甘油三酯水平增加三分位数的完全校正风险比[95%置信区间]：1 [参考]，1.21 [0.96-1.52]和1.09 [0.85-1.41] [趋势P = 0.90]）。相比之下，在完全校正的模型中，非空腹甘油三酯水平与心血管事件保持强的独立关系（水平增加三分位数的风险比[95%置信区间]：1 [参考]，1.44 [0.90-2.29]和1.98 [1.21-3.25] [趋势P = 0.006]）。在二次分析中，根据受试者最后一餐后的时间分层，餐后2 - 4小时测量的甘油三酯水平与心血管事件的相关性最强（最高与最低三分位数水平的完全校正风险比[95%置信区间]为4.48 [1.98-10.15] [趋势P < .001]），结论：在这组最初健康的女性中，非空腹甘油三酯水平与心血管事件的发生有关，独立于传统的心脏危险因素、其他血脂水平和胰岛素抵抗标志物;与此相反，空腹甘油三酯水平几乎没有显示出独立的关系。
Context The association of triglycerides with incident cardiovascular disease remains controversial. Although triglyceride levels are typically obtained in the fasting state, postprandial hypertriglyceridemia may play an important role in atherosclerosis.Objective To determine the association of triglyceride levels (fasting vs nonfasting) and risk of future cardiovascular events.Design, Setting, and Participants Prospective study of 26 509 initially healthy US women (20 118 fasting and 6391 nonfasting) participating in the Women's Health Study, enrolled between November 1992 and July 1995 and undergoing follow-up for a median of 11.4 years. Triglyceride levels were measured in blood samples obtained at time of enrollment.Main Outcome Measure Hazard ratios for incident cardiovascular events (nonfatal myocardial infarction, nonfatal ischemic stroke, coronary revascularization, or cardiovascular death).Results At baseline, triglyceride levels in fasting as well as nonfasting women correlated with traditional cardiac risk factors and markers of insulin resistance. During a median follow-up of 11.4 years, 1001 participants experienced an incident cardiovascular event (including 276 nonfatal myocardial infarctions, 265 ischemic strokes, 628 coronary revascularizations, and 163 cardiovascular deaths), for an overall rate of 3.46 cardiovascular events per 1000 person-years of follow-up. After adjusting for age, blood pressure, smoking, and use of hormone therapy, both fasting and nonfasting triglyceride levels predicted cardiovascular events. Among fasting participants, further adjustment for levels of total and high-density lipoprotein cholesterol and measures of insulin resistance weakened this association (fully adjusted hazard ratio [95% confidence interval] for increasing tertiles of triglyceride levels: 1 [reference], 1.21 [0.96-1.52], and 1.09 [0.85-1.41] [P = .90 for trend]). In contrast, nonfasting triglyceride levels maintained a strong independent relationship with cardiovascular events in fully adjusted models (hazard ratio [95% confidence interval] for increasing tertiles of levels: 1 [reference], 1.44 [0.90-2.29], and 1.98 [1.21-3.25] [P = .006 for trend]). In secondary analyses stratified by time since participants' last meal, triglyceride levels measured 2 to 4 hours postprandially had the strongest association with cardiovascular events (fully adjusted hazard ratio [95% confidence interval] for highest vs lowest tertiles of levels, 4.48 [1.98-10.15] [P < .001 for trend]), and this association progressively decreased with longer periods of fasting.Conclusions In this cohort of initially healthy women, nonfasting triglyceride levels were associated with incident cardiovascular events, independent of traditional cardiac risk factors, levels of other lipids, and markers of insulin resistance; by contrast, fasting triglyceride levels showed little independent relationship.