Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population
Concentration of apolipoprotein B is comparable with the apolipoprotein B/apolipoprotein A-I ratio and better than routine clinical lipid measurements in predicting coronary heart disease mortality: findings from a multi-ethnic US population
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DOI：
10.1093/eurheartj/ehn347
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发表时间：
2009-03-01
影响因子：
39.3
通讯作者：
Hamsten, Anders
中科院分区：
文献类型：
--
作者：
Sierra-Johnson, Justo;Fisher, Rachel M.;Hamsten, Anders
我们假设体重指数（BMI）正常但体脂（BF）含量高的受试者[正常体重肥胖（NWO）]有较高的心血管代谢紊乱患病率，心血管（CV）死亡风险较高。（NHANES III）和NHANES III死亡率研究，其BMI在正常范围内（18.5-24.9 kg/m2），并进行了完整的评估，包括身体成分评估、血液测量和CV风险因素评估。在中位随访8.8年后，> 99%的受试者可获得生存信息。我们使用BF%的性别特异性三分位数划分我们的样本。BF的最高三分位数（男性> 23.1%，女性> 33.3%）被标记为NWO。与低BF组相比，NWO受试者的代谢综合征患病率高出4倍（16.6vs.4.8%，P < 0.0001）。NWO受试者的血脂异常、高血压（男性）和CV疾病（女性）的患病率也较高。校正后，与低BF组相比，NWO女性的CV死亡风险显著增加2.2倍（HR = 2.2; 95%CI，1.03-4.67）。正常体重肥胖（定义为正常BMI和高BF含量的组合）与心脏代谢失调、代谢综合征和CV风险因素的高患病率相关。在女性中，NWO与CV mortality.Aims的风险增加独立相关，前瞻性研究表明，载脂蛋白测量可预测冠心病（CHD）风险;然而，证据相互矛盾，特别是在美国。我们的目的是评估载脂蛋白B（apoB）和载脂蛋白A-I（apoA-I）的测量是否可以提高预测CHD死亡的能力，超越传统的心血管（CV）危险因素和临床常规血脂测量的可能性。在7594名美国成年人的多种族代表性亚组中，（平均年龄45岁; 3881名男性和3713名女性，中位随访124人月）来自第三次全国健康和营养调查死亡率研究。应用多Cox比例风险回归。有673例CV死亡，其中432例死于CHD。apoB浓度[风险比（HR）1.98，95%置信区间（CI）1.09-3.61]，apoA-I（HR 0.48，95% CI 0.27-0.85）和总胆固醇（TC）（HR 1.17，95%CI 1.02-1.34）与冠心病死亡显著相关，而高密度脂蛋白胆固醇（HDL-C）（HR 0.68，95% CI 0.45-1.05）具有临界显著性。apoB/apoA-I比值（HR 2.14，95%CI 1.11-4.10）和TC/HDL-C比值（HR 1.10，95%CI 1.04-1.16）均与CHD死亡相关。仅载脂蛋白B（HR 2.01，95% CI 1.05-3.86）和apoB/apoA-I比值结论在美国人群中，载脂蛋白测定可显著预测冠心病死亡，与常规血脂和其他心血管危险因素无关（吸烟、血脂异常、高血压、肥胖、糖尿病和C反应蛋白）。此外，apoB单独检测CHD死亡的预测能力优于任何常规的临床血脂测量。载脂蛋白测量在未来的临床指南中不应被放弃。
We hypothesized that subjects with a normal body mass index (BMI), but high body fat (BF) content [normal weight obesity (NWO)], have a higher prevalence of cardiometabolic dysregulation and are at higher risk for cardiovascular (CV) mortality.We analysed 6171 subjects > 20 years of age from the Third National Health and Nutrition Examination Survey (NHANES III) and the NHANES III mortality study, whose BMI was within the normal range (18.5-24.9 kg/m(2)), and who underwent a complete evaluation that included body composition assessment, blood measurements, and assessment of CV risk factors. Survival information was available for > 99% of the subjects after a median follow-up of 8.8 years. We divided our sample using sex-specific tertiles of BF%. The highest tertile of BF (> 23.1% in men and > 33.3% in women) was labelled as NWO. When compared with the low BF group, the prevalence of metabolic syndrome in subjects with NWO was four-fold higher (16.6 vs. 4.8%, P < 0.0001). Subjects with NWO also had higher prevalence of dyslipidaemia, hypertension (men), and CV disease (women). After adjustment, women with NWO showed a significant 2.2-fold increased risk for CV mortality (HR = 2.2; 95% CI, 1.03-4.67) in comparison to the low BF group.Normal weight obesity, defined as the combination of normal BMI and high BF content, is associated with a high prevalence of cardiometabolic dysregulation, metabolic syndrome, and CV risk factors. In women, NWO is independently associated with increased risk for CV mortality.Aims Prospective studies indicate that apolipoprotein measurements predict coronary heart disease (CHD) risk; however, evidence is conflicting, especially in the US. Our aim was to assess whether measurements of apolipoprotein B (apoB) and apolipoprotein A-I (apoA-I) can improve the ability to predict CHD death beyond what is possible based on traditional cardiovascular (CV) risk factors and clinical routine lipid measurements.Methods and results We analysed prospectively associations of apolipoprotein measurements, traditional CV risk factors, and clinical routine lipid measurements with CHD mortality in a multi-ethnic representative subset of 7594 US adults (mean age 45 years; 3881 men and 3713 women, median follow-up 124 person-months) from the Third National Health and Nutrition Examination Survey mortality study. Multiple Cox-proportional hazards regression was applied. There were 673 CV deaths of which 432 were from CHD. Concentrations of apoB [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.09-3.61], apoA-I (HR 0.48, 95% CI 0.27-0.85) and total cholesterol (TC) (HR 1.17, 95% CI 1.02-1.34) were significantly related to CHD death, whereas high density lipoprotein cholesterol (HDL-C) (HR 0.68, 95% CI 0.45-1.05) was borderline significant. Both the apoB/apoA-I ratio (HR 2.14, 95% CI 1.11-4.10) and the TC/HDL-C ratio (HR 1.10, 95% CI 1.04-1.16) were related to CHD death. Only apoB (HR 2.01, 95% CI 1.05-3.86) and the apoB/apoA-I ratio (HR 2.09, 95% CI 1.04-4.19) remained significantly associated with CHD death after adjusting for CV risk factors.Conclusion In the US population, apolipoprotein measurements significantly predict CHD death, independently of conventional lipids and other CV risk factors (smoking, dyslipidaemia, hypertension, obesity, diabetes and C-reactive protein). Furthermore, the predictive ability of apoB alone to detect CHD death was better than any of the routine clinical lipid measurements. Inclusion of apolipoprotein measurements in future clinical guidelines should not be discarded.