Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study.
Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study.
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DOI：
10.2337/dc16-1958
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发表时间：
2017-04
期刊：
影响因子：
16.2
通讯作者：
Howard BV
中科院分区：
文献类型：
--
作者：
Lee JS;Chang PY;Zhang Y;Kizer JR;Best LG;Howard BV
高甘油三酯（TG）水平和低高密度脂蛋白胆固醇（HDL - C）水平是心血管疾病的危险因素。目前尚不清楚这种关系是否取决于血糖失调、性别或低密度脂蛋白胆固醇（LDL - C）水平。
我们研究了3216名参与者（40%为男性，41%患有糖尿病），他们是一个以社区为基础的美国印第安人前瞻性队列研究的基线人群，无心血管疾病（中位随访17.7年）。考克斯模型估计了与甘油三酯和高密度脂蛋白胆固醇联合状态相关的缺血性脑卒中和冠心病（CHD）的风险比（HRs）及95%置信区间，其中空腹甘油三酯水平≥150mg/dL为“高”，男性空腹高密度脂蛋白胆固醇水平<40mg/dL（女性<50mg/dL）为“低”。模型纳入了年龄、性别、体重指数（BMI）、吸烟、糖尿病、空腹低密度脂蛋白胆固醇水平、降压药物、体力活动、估算的肾小球滤过率以及尿白蛋白/肌酐比值。
高甘油三酯和低高密度脂蛋白水平的参与者患冠心病的风险比是甘油三酯和高密度脂蛋白水平正常者的1.32倍（95%置信区间1.06 - 1.64）。在患有糖尿病的参与者中观察到，高甘油三酯加低高密度脂蛋白水平与冠心病风险比增加1.54倍相关（95%置信区间1.15 - 2.06）（交互作用P值 = 0.003），与脑卒中风险比增加2.13倍相关（95%置信区间1.06 - 4.29）（交互作用P值 = 0.060），而在未患糖尿病的参与者中未观察到这种情况。高甘油三酯和低高密度脂蛋白水平与低密度脂蛋白胆固醇水平≥130mg/dL的参与者患冠心病的风险相关，但在低密度脂蛋白胆固醇水平较低的参与者中未观察到这种情况。性别似乎并未改变这些关联。
同时具有高甘油三酯和低高密度脂蛋白胆固醇的成年人，尤其是患有糖尿病的人，发生冠心病和脑卒中的风险增加。特别是低密度脂蛋白胆固醇水平≥130mg/dL的人，可能发生脑卒中的风险增加。
High triglyceride (TG) levels and low HDL cholesterol (HDL-C) levels are risk factors for cardiovascular disease. It is unclear whether this relationship depends on glycemic dysregulation, sex, or LDL cholesterol (LDL-C) level. We studied 3,216 participants (40% men, 41% with diabetes) who were free of cardiovascular disease at baseline in a community-based, prospective cohort of American Indians (median follow-up 17.7 years). Cox models estimated hazard ratios (HRs) and 95% CIs for incident ischemic stroke and coronary heart disease (CHD) in relation to combined TG and HDL-C status, where a fasting TG level ≥150 mg/dL was “high” and a fasting HDL-C level <40 mg/dL for men (<50 mg/dL for women) was “low.” Models included age, sex, BMI, smoking, diabetes, fasting LDL-C level, antihypertensive medications, physical activity, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio. Participants with high TG and low HDL levels had a 1.32-fold greater HR (95% CI 1.06–1.64) for CHD than those with normal TG and normal HDL levels. It was observed in participants with diabetes, but not in those without diabetes, that high TG plus low HDL levels were associated with a 1.54-fold greater HR (95% CI 1.15–2.06) for CHD (P value for interaction = 0.003) and a 2.13-fold greater HR (95% CI 1.06–4.29) for stroke (P value for interaction = 0.060). High TG and low HDL level was associated with CHD risk in participants with an LDL-C level of ≥130 mg/dL, but this was not observed in those participants with lower LDL-C levels. Sex did not appear to modify these associations. Adults with both high TG and low HDL-C, particularly those with diabetes, have increased risks of incident CHD and stroke. In particular, those with an LDL-C level ≥130 mg/dL may have an increased risk of incident stroke.