Coronary Heart Disease Risk Associated with Primary Isolated Hypertriglyceridemia; a Population-Based Study.
Coronary Heart Disease Risk Associated with Primary Isolated Hypertriglyceridemia; a Population-Based Study.
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原发性孤立性高脂血症与冠心病风险的相关性：一项基于人群的研究
DOI：
10.1161/jaha.120.019343
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发表时间：
2021-06
影响因子：
5.4
通讯作者：
Kullo IJ
中科院分区：
文献类型：
--
作者：
Saadatagah S;Pasha AK;Alhalabi L;Sandhyavenu H;Farwati M;Smith CY;Wood-Wentz CM;Bailey KR;Kullo IJ
高甘油三酯血症与冠心病风险增加有关，但这种关联通常归因于伴随的代谢异常。我们调查了基于人群的原发性孤立性高甘油三酯血症（PIH）的流行病学和相关心血管风险。我们在 1998 年至 2015 年间在明尼苏达州奥姆斯特德县确定了至少一种甘油三酯水平≥500 mg/dL 的成年人。我们还确定了甘油三酯水平<150 mg/dL 的年龄和性别匹配的对照。有 3329 人甘油三酯水平升高；排除伴有高胆固醇血症（高甘油三酯的次要原因）、年龄 <18 岁或记录不完整的患者后，517 名患者（49.4±14.0 岁，72.0% 男性）患有 PIH（甘油三酯 627.6±183.6 mg/dL）。经年龄和性别调整后的成人 PIH 患病率为 0.80% (0.72–0.87)； 60% 的患者确诊，46% 的患者服用降脂药物进行一级预防，24.1% 的患者甘油三酯水平低于 150 mg/dL。 PIH 与冠心病的关联减弱，但在调整人口、社会经济和传统心血管危险因素后仍然显着（风险比 [HR]，1.53；95% CI，1.06-2.20；P= 0.022）。 PIH 与脑血管疾病（HR，1.06；95% CI，0.65-1.73，P= 0.813）、外周动脉疾病（HR，1.27；95% CI，0.43-3.75；P= 0.668）或所有 3 项的复合终点（HR，1.28；95% CI， 0.92‐1.80；P=0.148）在调整后的模型中。 PIH 与冠心病事件相关（尽管在调整传统危险因素后有所减弱），支持甘油三酯在冠心病中的因果作用。这种情况相对普遍，但意识和控制力较低。
Hypertriglyceridemia is associated with increased risk of coronary heart disease but the association is often attributed to concomitant metabolic abnormalities. We investigated the epidemiology of primary isolated hypertriglyceridemia (PIH) and associated cardiovascular risk in a population‐based setting. We identified adults with at least one triglyceride level ≥500 mg/dL between 1998 and 2015 in Olmsted County, Minnesota. We also identified age‐ and sex‐matched controls with triglyceride levels <150 mg/dL. There were 3329 individuals with elevated triglyceride levels; after excluding those with concomitant hypercholesterolemia, a secondary cause of high triglycerides, age <18 years or an incomplete record, 517 patients (49.4±14.0 years, 72.0% men) had PIH (triglyceride 627.6±183.6 mg/dL). The age‐ and sex‐adjusted prevalence of PIH in adults was 0.80% (0.72–0.87); the diagnosis was recorded in 60%, 46% were on a lipid‐lowering medication for primary prevention and a triglyceride level <150 mg/dL was achieved in 24.1%. The association of PIH with coronary heart disease was attenuated but remained significant after adjustment for demographic, socioeconomic, and conventional cardiovascular risk factors (hazard ratio [HR], 1.53; 95% CI, 1.06‐2.20; P= 0.022). There was no statistically significant association between PIH and cerebrovascular disease (HR, 1.06; 95% CI, 0.65‐1.73, P= 0.813), peripheral artery disease (HR, 1.27; 95% CI, 0.43‐3.75; P= 0.668), or the composite end point of all 3 (HR, 1.28; 95% CI, 0.92‐1.80; P=0.148) in adjusted models. PIH was associated with incident coronary heart disease events (although there was attenuation after adjustment for conventional risk factors), supporting a causal role for triglycerides in coronary heart disease. The condition is relatively prevalent but awareness and control are low.