Improving the Prediction of Cardiovascular Risk: Interaction Between LDL and HDL Cholesterol
Improving the Prediction of Cardiovascular Risk: Interaction Between LDL and HDL Cholesterol
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DOI：
10.1097/01.ede.0000059227.04349.0d
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发表时间：
2003-05
期刊：
影响因子：
5.4
通讯作者：
S. Grover;M. Dorais;L. Coupal
中科院分区：
文献类型：
--
作者：
S. Grover;M. Dorais;L. Coupal
背景总胆固醇与高密度脂蛋白（HDL）胆固醇的比率（或低密度脂蛋白[LDL]与HDL的比率）目前被提倡用于估计与LDL和HDL胆固醇水平相关的冠状动脉风险。方法.我们分析了LDL和HDL胆固醇水平之间的关系，以预测未来冠状动脉事件的风险。使用来自脂质研究临床随访队列的数据，我们开发了多变量方程来预测4684名男性和女性的冠状动脉死亡，随访时间约为12年。我们使用这些方程来比较LDL/HDL比值的预测能力与LDL和HDL的独立效应以及LDL-HDL相互作用项。然后，我们使用每个模型来预测10年的冠心病死亡风险，这些风险是基于调整传统风险因素（如血压、性别、吸烟）后的各种血脂水平。结果LDL和HDL水平及其相互作用是冠心病死亡的独立危险因素。增加HDL的益处在LDL高的人中最强。相反，降低LDL的益处在HDL低的人中最大。我们在已发表的数据集中证实了这些观察结果，显示了高脂血症治疗的效果。基于LDL和HDL相互作用的治疗益处预测比没有相互作用的预测更准确。结论.单独的LDL/HDL比率可能无法完全捕获LDL和HDL之间的复杂相互作用以及各自与冠状动脉风险的关系。
Background. The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (or the ratio of low-density lipoprotein [LDL] to HDL) is currently advocated to estimate the coronary risk associated with LDL and HDL cholesterol levels. Methods. We analyzed the relation between LDL and HDL cholesterol levels to predict the risk of future coronary events. Using data from the Lipid Research Clinics Follow-up Cohort, we developed multivariate equations to predict coronary deaths among 4684 men and women followed for approximately 12 years. We used these equations to compare the predictive power of the LDL/HDL ratio with the independent effects of LDL and HDL and an LDL-HDL interaction term. We then used each model to forecast the 10-year risk of coronary death based on various lipid levels after adjustment for conventional risk factors (eg, blood pressure, gender, cigarette smoking). Results. Levels of LDL and HDL and the interaction between them are all independent risk factors for coronary death. The benefits of increasing HDL are strongest among persons with high LDL. Conversely, the benefits of decreasing LDL are greatest among those with low HDL. We confirmed these observations in a published dataset showing the effects of treatment of hyperlipidemia. Predictions of benefits of treatment that were based on interaction of LDL and HDL were more accurate than predictions without interaction. Conclusions. The LDL/HDL ratio alone may not fully capture the complex interaction between LDL and HDL and the relation of each to coronary risk.