HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk
HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk
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DOI：
10.1016/j.atherosclerosis.2009.02.041
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发表时间：
2009-10-01
期刊：
影响因子：
5.3
通讯作者：
Graham, I. M.
中科院分区：
文献类型：
--
作者：
Cooney, M. T.;Dudina, A.;Graham, I. M.
目的：我们的目的是澄清以前的一些不一致的作用，高密度脂蛋白胆固醇（HDL-C）作为一个CVD的保护factor.Methods：SCORE数据集包含的数据HDL-C为104,961人（45%的妇女）没有预先存在的冠心病（CHD）。这些数据来自7项汇总的欧洲前瞻性研究。使用考克斯比例风险模型，校正年龄、总胆固醇、收缩压、吸烟、糖尿病和体重指数，并按性别、年龄组、国家和SCORE CVD风险类别分层，检查HDL-C（五分位数和连续变量）对CVD和CHD死亡率风险的影响。HDL-C与CVD和CHD死亡率之间存在强烈的、分级的、独立的负相关关系。对于CVD死亡终点，女性和男性HDL-C每增加0.5 mmol/l的校正风险比分别为0.60（0.51，0.69）和0.76（0.70，0.83）。老年女性和男性相应的风险比分别为0.53（0.42，0.68）和0.79（0.64，0.98）。在所有SCORE CVD风险分层和年龄组的关系是显着的。结论：这种多变量分析，迄今为止最大的同类，已证实的反向，独立的，强大的HDL-C和CVD和CHD死亡率之间的分级关系。我们已经澄清了以前的建议，即这种关系在女性中更强，并且适用于所有年龄组。这是第一个前瞻性研究，以证明独立的关系，特别是在健康的老年妇女，并表明这种关系在所有水平的总心血管疾病的风险。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。
Objective: We aimed to clarify some previous inconsistencies regarding the role of high density lipoprotein cholesterol (HDL-C) as a CVD protective factor.Methods: The SCORE dataset contained data on HDL-C for 104,961 individuals (45% women) without preexisting coronary heart disease (CHD). These were from 7 pooled European prospective studies. The effect of HDL-C, both in quintiles and as a continuous variable, on risk of CVD and CHD mortality was examined, using Cox proportional hazards model, adjusted for age, total cholesterol, systolic blood pressure, smoking, diabetes and body mass index and stratified by gender, age group, country and category of SCORE CVD risk.Results: A strong, graded, independent, inverse relationship between HDL-C and both CVD and CHD mortality was demonstrated. Adjusted hazard ratios per 0.5 mmol/l increase in HDL-C were 0.60 (0.51, 0.69) and 0.76 (0.70, 0.83) in women and men, respectively for the CVD mortality endpoint. The corresponding hazard ratios were 0.53 (0.42, 0.68) and 0.79 (0.64, 0.98) in elderly women and men, respectively. The relationship was significant in all SCORE CVD risk strata and age groups.Conclusions: This multivariable analysis, the largest of its kind to date, has confirmed the inverse, independent, strong and graded relationship between HDL-C and both CVD and CHD mortality. We have clarified previous suggestions that the relationship is stronger in women and that it applies in all age groups. This is the first prospective study to demonstrate the independent relationship specifically in healthy elderly women and to show that the relationship holds at all levels of total CVD risk. (C) 2009 Elsevier Ireland Ltd. All rights reserved.