Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case-control study with controls from the patients' recruitment area.
Enigma of the cholesterol paradox in acute myocardial infarction: lessons from an 8-year follow-up of all-cause mortality in an age-matched and sex-matched case-control study with controls from the patients' recruitment area.
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急性心肌梗死中胆固醇悖论的谜：在年龄匹配且性匹配的病例对照研究中，全因死亡率进行了8年随访的教训，并从患者招聘区域进行对照。
DOI：
10.1136/bmjopen-2021-057562
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发表时间：
2022-07-27
期刊：
影响因子：
2.9
通讯作者：
Ohrvik J
中科院分区：
文献类型：
--
作者：
Nilsson G;Leppert J;Ohrvik J
目的：评价总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)对急性心肌梗死(AMI)患者和对照组长期全因死亡率(ACM)的影响。配对病例对照研究，随访8年。瑞典瓦斯特拉斯的瓦斯特曼兰县医院。2005年3月至2010年5月连续入院的急性心肌梗死患者和来自普通人群的年龄匹配和性别匹配的对照组。ACM.急性心肌梗死患者和对照组的危险人年为11 667(病例：5780，对照组：5887)。在随访期间，199名患者和84名对照死亡，这意味着每100名高危人群中有3.4名患者死亡，1.4名对照死亡。未经校正的COX分析显示，通过降低TC和LDLc水平，两组患者(HR=0.7095%CI 0.62至0.79，p<；0.001， 和HR=0.64，95%CI 0.56至0.74，p<；0.001)和对照组(HR=0.73，95%CI 0.60至0.89，p=0.002， 和HR=0.74，95%CI 0.59至0.93，p=0.010)的死亡率显著增加。在调整了临床变量后，患者的结果仍然显著。对死亡率与TC和LDL-C之间关系的COX分析揭示了以下模式。患者：中位数以下为TC和LDL-C水平，与死亡率呈显着负相关；中位数以上与死亡率无关。对照组：中位数以下为TC和低密度脂蛋白胆固醇水平，与死亡率呈显著负相关；中位数以上为低密度脂蛋白胆固醇水平，与死亡率显著正相关。发病12 后采血的患者平均低密度脂蛋白胆固醇水平比采≤12 小时的低密度脂蛋白胆固醇低0.41 /L(P=0.030)。这种低密度脂蛋白的下降是由持续的急性心肌梗死合理地引起的，反映了患者和对照组之间低密度脂蛋白水平的差异。在急性心肌梗死患者中，较低的TC和LDL-C水平独立地预示较高的ACM。在他们的对照组中，低密度脂蛋白胆固醇水平高于中位数独立预测更高的ACM。这项研究增加了支持胆固醇悖论存在的证据。
To assess the impact of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) on long-term all-cause mortality (ACM) in patients with acute myocardial infarction (AMI) and controls. Matched case–control study with 8-year follow-up. Vastmanland County Hospital, Vasteras, Sweden. Consecutive patients with AMI admitted to the coronary care unit from March 2005 to May 2010 and age-matched and sex-matched controls from the general population. ACM. Person-year at risk among patients with AMI and controls was 11 667 (cases: 5780 and controls: 5887). During follow-up, 199 patients and 84 controls died, implying 3.4 deaths among patients and 1.4 among controls per 100 person-years at risk. Unadjusted Cox analyses showed significantly increasing mortality by decreasing TC and LDL-C levels in both patients (HR=0.70, 95% CI 0.62 to 0.79, p<0.001, and HR=0.64, 95% CI 0.56 to 0.74, p<0.001) and controls (HR=0.73, 95% CI 0.60 to 0.89, p=0.002, and HR=0.74, 95% CI 0.59 to 0.93, p=0.010). After adjusting for clinical variables, the results for the patients remained significant. Cox analyses of the relations between mortality and TC and LDL-C below and above their respective medians revealed the following pattern. Patients: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians there were no relations with mortality. Controls: below medians were TC and LDL-C levels significantly inversely related to mortality; above medians were LDL-C levels significantly positively related to mortality. Mean LDL-C level in patients with blood sampled >12 hours after symptom onset was 0.41 mmol/L lower than that in patients with blood sampled ≤12 hours (p=0.030). This LDL-C decrease was reasonably caused by ongoing AMI and reflects the difference in LDL-C levels between patients and controls. In patients with AMI, lower TC and LDL-C levels independently predict higher ACM. In their controls, LDL-C levels above the median independently predict higher ACM. This study adds to the body of evidence supporting the existence of a cholesterol paradox.
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影响因子：
120.7
作者：
Stamler, J;Daviglus, ML;Neaton, JD
通讯作者：
Neaton, JD
影响因子：
3.3
作者：
Ibanez, Borja;James, Stefan;Widimsky, Petr
通讯作者：
Widimsky, Petr
影响因子：
39.3
作者：
Parish S;Peto R;Palmer A;Clarke R;Lewington S;Offer A;Whitlock G;Clark S;Youngman L;Sleight P;Collins R;International Studies of Infarct Survival Collaborators
通讯作者：
International Studies of Infarct Survival Collaborators
影响因子：
2.9
作者：
Ravnskov U;Diamond DM;Hama R;Hamazaki T;Hammarskjöld B;Hynes N;Kendrick M;Langsjoen PH;Malhotra A;Mascitelli L;McCully KS;Ogushi Y;Okuyama H;Rosch PJ;Schersten T;Sultan S;Sundberg R
通讯作者：
Sundberg R
影响因子：
168.9
作者：
Schatz, IJ;Masaki, K;Curb, JD
通讯作者：
Curb, JD