Relative atherogenicity and predictive value of non-high-density lipoprotein cholesterol for coronary heart disease
Relative atherogenicity and predictive value of non-high-density lipoprotein cholesterol for coronary heart disease
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DOI：
10.1016/j.amjcard.2007.11.046
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发表时间：
2008-04-01
影响因子：
2.8
通讯作者：
Schaefer, Ernst J.
中科院分区：
文献类型：
--
作者：
Miller, Michael;Ginsberg, Henry N.;Schaefer, Ernst J.
虽然低密度脂蛋白胆固醇（LDL-C）是冠心病的一个公认的致动脉粥样硬化因子，但它并不能完全代表高甘油三酯（TG）水平下致动脉粥样硬化脂蛋白相关的风险。构成非高密度脂蛋白胆固醇（非HDL-C）的组分脂蛋白包括致动脉粥样硬化的富TG脂蛋白、富TG脂蛋白的胆固醇酯富集残余物和脂蛋白（a）。最近的观察和干预研究表明，非HDL-C对心血管风险和死亡率的预测价值优于低密度脂蛋白胆固醇，并且非HDL-C与血浆载脂蛋白B水平高度相关。目前，国家胆固醇教育计划成人治疗小组III指南将非HDL-C确定为达到LDL-C目标后TG升高（>= 200 mg/dl）患者的次要治疗目标。在患有冠心病或冠心病等同风险的患者中，可选的非HDL-C目标是< 100 mg/dI。为了达到非HDL-C目标，他汀类药物治疗可以加强或与依折麦布，烟酸，贝特类或ω-3脂肪酸联合使用。总之，非HDL-C仍然是TG升高患者的重要治疗靶点，尽管其广泛采用尚未在治疗血脂异常患者的医疗保健专业人员中站稳脚跟。(C)2008年爱思唯尔公司
Although low-density lipoprotein cholesterol (LDL-C) is a well-established atherogenic factor for coronary heart disease, it does not completely r epresent the risk associated with atherogenic lipoproteins in the presence of high triglyceride (TG) levels. Constituent lipoproteins constituting non-high-density lipoprotein cholesterol (non-HDL-C) include atherogenic TG-rich lipoproteins, cholesteryl ester-enriched remnants of TG-rich lipoproteins, and lipoprotein(a). Recent observational and intervention studies suggest that the predictive value of non-HDL-C for cardiovascular risk and mortality is better than low-density lipoprotein cholesterol and that non-HDL-C correlates highly with plasma apolipoprotein B levels. Currently, the National Cholesterol Education Program Adult Treatment Panel III guidelines identify non-HDL-C as a secondary target of therapy in patients with TG elevation (>= 200 mg/dl) after the attainment of LDL-C target goals. In patients with coronary heart disease or coronary heart disease risk equivalents, an optional non-HDL-C goal is < 100 mg/dI. To achieve the non-HDL-C goal, statin therapy may be intensified or combined with ezetimibe, niacin, a fibrate, or omega-3 fatty acids. In conclusion, non-HDL-C remains an important target of therapy for patients with elevated TGs, although its widespread adoption has yet to gain a foothold among health care professionals treating patients with dyslipidemia. (C) 2008 Elsevier Inc.